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ONSrrE VVAS 1TEWATER TREATMENT SYSTEM PERWT <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 INSP CTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /� / jg�TY/ZIP �p n�F1r \/ 2 <br /> CROSS STREET A 64 41,,444nAz �f.� APN (�R 1 3 017- PARCEL SIZE ` <br /> OWNER NAME PHONEr/ <br /> OWNER ADDRESS �3 / CITY/STATEIZIOP��l//��u�/ <br /> CONTRACTOR s e)' t PHONE �I L' —/ 77 / y <br /> CONTRACTOR ADDRESS /b22� h'� CITYISTATE/ZIP <br /> LICENSE ❑LIC 42 ❑1_IC-36 01HER NUMBE 6 EXPIRATION DATE /2—'J C f'.U <br /> WATER TABLE DEPTH:_ / It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT 171 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: n NUMBER OF EMPLOYEES: <br /> 64-ASEPTIC TANK TYPE/MFG �i°� CAPACITY /ol OU gal #OF COMPARTMENTS <br /> 0 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It 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 a S ft <br /> I <br /> DISTANCE TO NEAREST WELL Ago- ft FOUNDATION /CJ�� ft PROPERTY LINE S- '� ft <br /> QJ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CJ 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 /> A�AEEPAGE PITS NUMBER oL WIDTH '-FD(/,) ft DEPTH 017S, ft <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 /> MINOW 48 HOUR 4DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE G U DATE <br /> U/ <br /> 1VU, N <br /> F <br /> DEPARTMENT USEONLY r <br /> Application AcceptedAy 9" Date_ g Areaq Employee ID# fir! <br /> Final Inspection By Date 707-0 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Charac er: <br /> COMMENTS 0 W ' yin W vjiervi Wk <br /> (tee- i - qg l h. o ✓ }} <br /> PE Sc Received Checic / Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Invoice# Permit ID# <br /> l lj v-x/ 52 C�Z <br /> L P I / �_ " -t- I 0 0 y Gv" /6 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 "��11 / J <br />