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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 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS ,� �� J F. �� /� CITY/ZIP Lb(� `IS0?_ID <br /> CROSS STREET tiCA I( APN 26 a a PARCEL SIZE f I 0 9 <br /> v <br /> OWNER NAME L IIr�S G1)� /"� �I PHONk-' 2J ) J Oy -013 � m <br /> OWNER ADDRESS S �I O rJ�t���u/ ��" CITY/STATE/ZIP Ai"11^ <br /> CONTRACTORISseh < vr PHONE�2c>�-2 2 J/ —Y J-3 I <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP '�i�r�/ CA. <br /> LICENSE 11,.C-42i_C-42 ❑ A <br /> FJC-36 OTHER ' 1 NUMBER-�)/J^��J 7 EXPIRATIONDATE <br /> WATER TABLE DEPTH: 1 O ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # r BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATIO//N REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENTL-e,4,,4 .`r OUT-OF-SERVICE SEPTIC SYSTEM IJ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL�r PA"e l ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 f f V I e Wel- 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 /> 1 <br /> Ell LEACH LINES 0 LEACHING CHAMBERS 2� Z I;•. #OF LINES LENGTH OF LINESy ft <br /> DISTANCE TO NEAREST WELL /�' ' ft FOUNDATION S,)r ft PROPERTY LINE '�'JU t 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 /> O SEEPAGE PITS NUMBER WIDTH 3. ft DEPTH ' j ft <br /> DISTANCE TO NEAREST WELL /,'-r0 ft FOUNDATION ZO ft PROPERTY LINE /LJ J 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE l <br /> hl <br /> LO � A <br /> O 1 <br /> DEPARTMENT USE ONLY pARryFL <br /> Application Accepted By � Lfy Date 11 S OHO Area Q� Employee ID# %rt <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTSon }DP vfP�"/Jj� IIY1Ps. <br /> PE SC Received Check-#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Se ice Re u St <br /> `-310 ls- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />