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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JCAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT C-- CALL 209 953-7697 FOR INSPECTIONS r--� EXPIRES 1 YEAR FROM DATE ISSUED <br /> ECROSS <br /> EsS ! D 33 1 <br /> I vi CITY/ZIP j v <br /> r�J P L_L_C 1` APN 1 ZZ-'- y� C)� PARCEL SIZE /,I -`- O <br /> REET _AME , Jc,> PHONE /,�L.17S ou JOs G T , CITY/STATE/ZIPDDRESS <br /> CONTRACTOR L-I UC O-�� 6t��_V �U 1(zt7N Wt�>uTA L- PHONE 3L.1-03-19 <br /> CONTRACTOR ADDRESS �01 u•`r '` �{ C[TY/STATE21P 1"'O� 1 C'� I S O <br /> LICENSE L'i.'-.C-42 L]'C-36 OTHER �1T NUMBER f.�/VD 1 EXPIRATION DATE ��30 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # f BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT .. OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It 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 It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> LlSEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> MINIM H D N TI E REQUIRED FOR IN PE TI N -PLEASE CALL(209)953-769 <br /> SIGNED <br /> 5 - <br /> SIGNED / TITLE P14'OJ DATE <br /> ti <br /> ��VFO <br /> �.t_ I I I I I QAA 0 ?020 <br /> E NC <br /> ON <br /> L� <br /> DEPARTMENT U JE'0N�Y Area X «r Employee In# � qR MFN� <br /> Application Accepted By i G — 1�— <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B sh Remitted Service Rqquest# <br /> Ll�aa <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />