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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 1� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 7C1f)t� KCISS"An 'In '�hij Lem }i CITY/ZIP C44 <br /> l m <br /> CROSS STREET S, r r6 I reA I I APN oa���o i a PARCEL SIZE <br /> 0 <br /> yn <br /> 0 <br /> OWNER NAME 01 rV'y F-0 Lrer <br /> PHONE <br /> 7Line <br /> OWNER ADDRESS SZ)1 I'I, (/���r�z I f L I n e cR-G� CITY/STATE/ZIP rC;I C <br /> CONTRACTOR 04 ,1u25 C��+CrCL► /`'S' PHONE <br /> CONTRACTOR ADDRESS ).CJ 7X l :7 CITY/STATE/ZIP <br /> LICENSE 111_C-42 ❑f IC-36 OTHER A NUMBER - - t1 EXPIRATION DATE lL7a <br /> WATER TABLE DEPTH: �fo55 ���� I ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I I NEW INSTALLATION REPAIR/ADDITION i_1. ENGINEER DESIGNED/ALTERNATIVE <br /> 1 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Lw,4ESIDENCE ❑ 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 �c(�,�`[, ft FOUNDATION l0� ft PROPERTY LINE -S' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0,-'LEACH LINES LEACHING CHAMBERS #OF LINES 5� LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL S ft FOUNDATION 13' ft PROPERTY LINE S , 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 /> i <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 1 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 4DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 /953-7697 <br /> SIGNED TITLE DATE <br /> 9 <br /> 44 111 <br /> In Z-il <br /> r ' <br /> A <br /> N (Jt <br /> DEPARTMENT U E ONLY <br /> Application Accepted By Date 6 Area <br /> S � Employee ID#�_ <br /> Final Inspection ByDate 2 (I l Z 1 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of Pit/Sump Soil Character: <br /> COMMENTS Le�.c�� diel1 ,�in� L?');/Il,�c �1✓1PS f" YPI�GiiYl Tier fit L-lel s ,,a;tlli)I <br /> se t(v,�c ks Der r r-�L 7 /1 1�Z <br /> PE SC Received Gfiecw Amount Permit/ <br /> Code INFO B `Cash Remitted Date Service Request# Invoice# Permit ID# <br /> Lid 1,0 ;- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />