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ONSITE WASTEWATER <br />TREATMENT <br />SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Date <br />1868 E. HAZELTON AVENUE - STOCKTON CA <br />95205 - (209) 468-3420 <br />IV VN-1'StFUNUACLt YtRMII IiHLL ZUJ J�3�/OJ/ FUH /NSPEGTIONS tXPIRE5 7 TEAR FROM DATE ISSU <br />JOB ADDRESS I Z Cgi 1J�O�GI .�N • P ]y yC PEEK LN CITY%ZIIPP L <br />ry l 0 <br />CROSS STREET k LLC 6 Q APN 0 _ I ( 0 _ C) PARCEL SIZEG(y ` 3 <br />OWNER NAME (\jkRl GPc iZ(�►0 L'L PHONE 14 S L � 5 / (pT— <br />OWNER ADDRESS S f�%wt G CITY/STATE/ZIP p <br />CONTRACTOR L• L V C OAK GE U pEaIQ �Ile•�o-#1 MCNTft L PHONE <br />CONTRACTOR ADDRESS 401 w t 0^1< S / CITY/STATE/ZIP UepGi ` �5 2 4 0 <br />LICENSE ❑ ..0-42 ❑I:: C-36 OTHER C66pm NUMBER Z �S I EXPIRATION DATE T —� U Z <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: <br />PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: _. NEW INSTALLATION ._. REPAIR/ADC <br />_. REPLACEMENT .... OUT -OF -SERVICE SEPTIC SYSTEM C'. DESTRUCTION <br />Coordinates X <br />LAND USE APPLICATION #_ <br />IN I; ENGINEER DE: <br />11 <br />INSTALLATION WILL SERVE: RESIDENCE L1COMMERCIAL L OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />L3 SEPTICTANK <br />TYPE/MFG <br />❑ GREASETRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />TERNATIVE <br />al # OF COMPARTMENTS <br />g <br />gal # OF COMPARTMENTS <br />It PROPERTY LINE ft <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 />MINIMUM4&4911R AD CE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED A TITLE PXOJ DATE 44" "4 <br />vey, <br />Application Accepted By �'LiL_� Date `'I S •� Area � Employee ID# 1J/ r ''MF��, <br />Final Inspection By r`�!r"� � Date 2- ?% ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS J� {q/� 266 M•~/ Pa Apu f z7•7A /ww ;.t <br />PE SC Received Amount Permit/�. <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />Date <br />Invoice# <br />PermitlD# <br />Code <br />INFO <br />B <br />Cash <br />Remi ed <br />Service Re uest # <br />4aaa <br />say <br />1�a <br />: ' <br />IS <br />SI.P <br />3 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />