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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 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS / �1 CITY/ZIP 2 <br /> CROSS STREET - z ��ll/. J APN Id1100636 PARCEL SIZE 0 J <br /> Q C 0 <br /> OWNER NAME ��� w ���/�dY� PHONEy2(J / np �� v <br /> OWNER ADDRESS CITY/STATE/ZIP [� <br /> CONTRACTOR <br /> ' PHONE--oO'eo'4 Q " ;2 <br /> CONTRACTOR ADDRESS -CITY/STATE/ZIP <br /> LICENSE ❑L7C-42 ❑LIC-36 OTHER14 � NUMBED XPIRATION DATE CT'3,z — <br /> WATER TABLE DEPTH: 11?SS A)4tYI I ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ! NEW INSTALLATIONADDITION C! ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT [i OUT-OF-SERVICE SEPTIC SYSTEM I' DESTRUCTION <br /> INSTALLATION WILL SERVE: 'B'RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACIT 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 U LEACHING CHAMBERS_ i �( 02 #OF LINES LENGTH OF LINES ft <br /> 117 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH 027 ft LENGTH 3 a ft DEPTH 1C. a y9 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 /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH 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 /> "1—M--UL;?=wR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SI E TITLE DATE e�— <br /> IN 1,0 N <br /> ENVIII O M N L <br /> DEPARTMENT USE ONLY I <br /> Application Accepted By `_ Date /t ovZ9 Area 3 Employee ID# CJ <br /> Final Inspection By Date SPECIAL PERMIT -Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 'Xi.> dl s �e 'I oi'l P�r ,�+1� ID's• /YI�V,h �> J• <br /> -Pihzlym !�� <br /> w04 ;V7 '-0 o o-�ea . l-{p,✓ by 3I <br /> PE SC Received Check#/ Amount at Permit/ Invoice# Permit ID# <br /> Code INFO Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />