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dt <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Qom_ n/12 wnu 61- CITY/ZIP C+ v: <br /> CROSS STREET /U �ZJ}C�/j APN l/L)t�J L 0 PARCEL SIZE SO O <br /> OWNER NAME iC. Ci r k I I� L �J l 1. PHONE C '1 <br /> OWNER ADDRESS <br /> tl�rl oy )-,76 CrrY/STATE/ZIP`91- <br /> CONTRACTOR <br /> /kl.ropo <br /> CONTRACTOR C,LLI 1/�n-7L /!/ 1/eV Xe— 1-� PHONE 1(O/- <br /> CONTRACTO,,��R//A��DDRESS 3 �(� 1Uy //�//� �Iy�1 f CITY/STATE/ZIP <br /> LICENSE ;KC-42 ❑ C-36 OTHER NUMBER C L " EXPIRATION DATE 691--1 <br /> WATER TABLE DEPTH: !S J It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Li PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATIONREPAUVADDRION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM - DESTRUCTION <br /> INSTALLATION WILL SERVE: fX RESIDENCE ❑ COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG 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 /> pti LEACH LINES _ LEACHING CHAMBERS #OF LINES ^� LENGTH OF LINES U ft <br /> DISTANCE To NEAREST WELL II'- ft FOUNDATION JC/' ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH it <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl <br /> I� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> aft <br /> q SUMPS WIDTH Z It LENGTH I V ft DEPTH I Z ft <br /> DISTANCE TO NEAREST WELL 757 i It FOUNDATION 7S It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It 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 /> MINIMUM 48 HOUR ADVANCE E REQUIRED OR INSPECTIONS-PLEAW CALL 2 -7 7 <br /> SIGNED � _ TITLE DATE ZO <br /> MEN 1 <br /> EIVED <br /> =11110 2 2020 <br /> UIN COUNTY <br /> I ONMENTAL <br /> L H DEPARTMENT <br /> DEPARTMENTfiUISE ONLY <br /> Application Accepted By �i� Date .11 Oa'U Area Lj - Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Surpp Soli Character: <br /> COMMENTS SV f(.YIC i­Irlihc p,bp'e�!Y md",)n� rY nv7l• <br /> PE SC Received Check#/ Amount PermiU # <br /> Code INFO Cash Date Remitted Service Re uest# Invoice Permit ID# <br /> Lid 0 s" 5 30�5 T—2,75 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />