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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 J EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRES:. 2 �� `/i�eJG/7.f /�� CITY/ZIP 411 <br /> CROSS STREET l��xp APN O PARCEL SIZE S• b�. v <br /> /L' U ?c!50 / <br /> OWNER NAME J �1l PHONE <br /> OWNER ADDRESS s'401 L %e13y CITY/STATE/ZIP /VGf <br /> d <br /> C/ S ,.3 <br /> CONTRACTOR i � n�- PHONE <br /> CONTRACTOR ADDRESS 3�y� ✓"- YYJ��� lir CITY/STATE/ZIP <br /> LICENSE 119642 1111C-36 OTHER NUMBER 751U5'S� EXPIRATION DATE 0�i�Z3 <br /> WATER TABLE DEPTH: 90-100 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 610 b Ll 01 3 L 1 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I_ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ? NUMBER OF EMPLOYEES: <br /> 81 SEPTIC TANK TYPE/MFG � �� CAPACITY JAG gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL /6k> ft FOUNDATION �7 ft PROPERTY LINE Sy ` ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES SS ft <br /> DISTANCE TO NEAREST WELL 42-o'l- ft FOUNDATION ft PROPERTY LINE S d 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 3 WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL J S< - ft FOUNDATION ft PROPERTY LINE SCJ> 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 ADZANCE NOTICE RE IRED FOR INSPECTIONS/- PLEASE CALL 2 953-7697 <br /> SIGNED —� TITLE ���u�c�� DATE Z� <br /> r <br /> WAF <br /> N <br /> Ai — <br /> IV, <br /> O lfv N <br /> 4EE <br /> DEPARTMENT USE ONLY <br /> Application Accepted By �i� Date 8 do Area Employee ID# <br /> Final Inspection By Date li3 Z'N ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: �tP� 'P Pit/Sump Soil Character: <br /> COMMENTS C�in►IP,I � .. P,r <br /> PE SC Received a Amount Date Permit/ Invoice# Permit ID# <br /> CodeINFO B Cash Remitted Service Request# <br /> LIRIT_ )17 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />