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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 53-7697 FOR INSPECTIONS EXP <br /> iIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP C Yq V w <br /> /� j <br /> CROSS STREET S +i APN c� 1 `, O — C7 PARCEL SIZE Zy K-L-iep <br /> ­J� v <br /> OWNER NAME I lJ V+�(� C C� ✓L<, PHONE C <br /> f <br /> OWNER ADDRESS (` �1 L( L( �(: ( 1 / f � l�L CITY/STATE/ZIP � S c- 44 �G✓tom `v�/y�� N <br /> CONTRACTOR V`�\� PHONE 0� J <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-42 ❑JC/-'36 OTHER NUMBER EXPIRATION DATE e <br /> WATER TABLE DEPTH: y—7)O ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# b " Ll LAND USE APPLICATION# <br /> TYPE OF WORK: 1K NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> i i REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFGIr��a At:i C: CAPACITY ( gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG `` _�/- CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL v�� ,,wC r l ft FOUNDATION. ft PROPERTY LINE ( ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES I? LENGTH OF LINESj CJ' ft <br /> DISTANCE TO NEAREST WELL 5��"� z L ft FOUNDATION -23 PROPERTY LINE 1—� 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 /> ❑ 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 PROPERY 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953--7697 <br /> SI D TITLE DATE f� <br /> 1S' <br /> N N <br /> r <br /> DEPARTMENT USE ONLY n FNT <br /> Application Accepted By -G— G v Date '7/ 7 Area f Employee ID#� <br /> Final Inspection By DateX 116 COZI ElSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> a 1 1 117 s 12 35 <br /> Y ►i �-I S <br /> 42-D1 ITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />