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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 11 CYEAR FROM DATE ISSUED <br /> JOB ADDRESS `7" Oy ,plS�,p CITY/ZIP <br /> CROSS STREET APN rS70 S LI De PARCEL SIZE p <br /> OWNER NAME ,S �- �IfIN[/ P` v'42e r� PS PHONEgo� <br /> 07: S <br /> OWNER ADDRESS I� CITY/STATE/ZIP <br /> CONTRACTOR �&.g4 2!?6 M Pf/Z'Sr 4 Cn' PHONE 7 6 j qJ 1�}-� <br /> CONTRACTOR ADDRESS � � �;� nC-�1 CITY/STATE/ZIP 4�� 6ktAdz�/ <br /> LICENSE P C-42 I.1 C-36 OTHER NUMBEREXPIRATIONDATE <br /> WATER TABLE DEPTH: S D _6,/ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Ll NEW INSTALLATION A J REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I_I COMMERCIAL I 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i L/&- <br /> J <br /> LEACH LINES LEACHING CHAMBERS r/ #OF LINt � � LENGTH OF LINES 7 It <br /> r�,c- <br /> DISTANCE TO NEAREST WELL J C/ , ft FOUNDATION �O lz� ft PROPERTY LIN )� It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST W ELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 SUMPS WIDTH ft LENGTH 1 It DEPTH ft <br /> J DISTANCE To NEAREST WELL ft FOUNDATION b ft PROPERTY LINE S /' ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft 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 /> MINIIO1 M 48 HOURADVANOt NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Gb DATE ^� <br /> + T L <br /> H LH EAT EN <br /> / DEPARTMENT S ONLY <br /> Application Accepted B Z-z- Date 7 Z, Area "I Employee ID# <br /> Final Inspection By Date 2 ElSPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 1r5fHr�' �c: n<. Lx+s-hp( hoeg Ib )'eWA01. E yj:s -Jrs S S�PYvI OYT FXl3}lhG �o� <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cas Remitted Service Request# <br /> a l C) 15 3oa61 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />