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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 FROV DATE ISSUED <br /> JOB ADDRESS 7 L CITY/ZIP <br /> .:I <br /> m <br /> CROSS STREET APN PARCEL SIZE_ p <br /> 0 <br /> OWNER NAME C.. L'14111�0 <br /> PHONE <br /> OWNER ADDRESS aC" CITY/STATE/ZIP /11 n / Q rV 67 3& <br /> /L77�^ <br /> CONTRACTOR /1 <br /> N <br /> PHONE <br /> CONTRACTOR ADDRESS ^�L�J �t�/V Z� t :/� CITY/STATE/ZIP <br /> LICENSE ❑❑C-42 DOC-36 OTHER NUMBER7/5 LEXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 1 NEW INSTALLATION V REPAI DDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM F1 DESTRUCTION <br /> INSTALLATION WILL SERVE: EP RESIDENCE ❑ COMMERCIAL ! / ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 7 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 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 e� #OF LINES LENGTH OF LINES U ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION4,�.) - ft PROPERTY LINE 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 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 /> MINIMU 8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE 3o Z:2 <br /> 'it lmn <br /> UI C DU <br /> IIEA <br /> L <br /> PARTMENT USE GNLY A !� <br /> Application Accepted B Date a Area Employee ID#QTY • ,�it,n S <br /> Final Inspection By Date <?>1112j ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PkSump Soil Character: <br /> COMMENTS-o ma ; LJiV nRjTX*14,Z <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B emitted Date Service Request# Invoice# Permit ID# <br /> l t!nd Jh 0'F "0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />