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i <br /> l <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS • DS-,3 1'G:Lr Y &0b CITY/ZIP 10* 0-t(l d,9l` CO- <br /> CROSS STREET I +ry--T--ril"� /t.'7Jy1r APN �g � f/� PARCEL SIZE p <br /> 0 <br /> OWNER NAME c-U tZ J�Vylf'S PHONE ,mom <br /> + /J / m <br /> OWNER ADDRESS `•-,-75� S 1 F'1, /G � ?S}C' C CITY/STATE/ZIP 1` f�C'��G 1 K A �S3b <br /> CONTRACTOR i ,I�! S C." �! �4 PHONE L1 S� �L 276 5 d q <br /> CONTRACTOR ADDRESS &2X (�.�"n CITY/STATE/ZIP <br /> LICENSE ❑I IC-42 Ell IC-36 OTHER NUMBER <br /> -� � EXPIRATION DATE £.a <br /> WATER TABLE DEPTH: I`� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# S LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM F1 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL C OTHER <br /> MBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG ,}-L CAPACITY j ?�jj gal #OF COMPARTMENTS ai <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL l ft FOUNDATION ft PROPERTY LINE 75 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 1 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES r-F. LENGTH OF LINES j ft <br /> DISTANCE TO NEAREST WELL , ft FOUNDATION ,�� ft PROPERTY LINE ��� ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0/.�SEEPAGE PITS NUMBER 2= WIDTH 4.o)II ft DEPTH a--,,I ft <br /> DISTANCE TO NEAREST WELL l ft FOUNDATION I ft PROPERTY LINE 56 ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 H U ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE (:,�bYI .R C Com} C-C DATE <br /> �r <br /> 0 <br /> %4A ir 0 <br /> V / <br /> N ry <br /> E T <br /> DEPARTMENT USE ONLY <br /> Application Accepted By vl� Date 7 ei 070X-) Area Employee ID# s <br /> Final Inspection By Date$"1/—Zi26 C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Ne,-✓ SFK. 1 ler -71' <br /> PE SC Received he Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Bv s Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />