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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)4683420 <br /> NON-REFUNDABLE PERMIT 7,r CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1-LI <br /> FROM DATE ISSUED <br /> JOB ADDRESS J Z 4- �J 7 W, S I 1 1�-�7'��""r /2'� CITY/ZIP 1-0 L7 I C7 --f Z <br /> CROSS STREET c�C �"/ES APN U_ZK-Iy- �u "f V�I PARCEL SIZE 7� <br /> OWNER NAME �` Sft113�EIZ PHONE �/V S-I L-1) <br /> y <br /> OWNER ADDRESS U -DG-E trU UU ' CITY/STATE/ZIP <br /> CONTRACTOR L-I VC CAK bf=^/ulln��r`i(- PHONE 3b`1-U37S- q <br /> CONTRACTOR ADDRESS z4O� t ij' �',�� S7. CITY/STATE/ZIP ('z-9 1 C'`/� <br /> LICENSE ❑i iC-42 ❑C C-36 OTHER C E NUMBER ZI ' EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I� PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION i7 REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> 17 REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM 1.1 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ 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 ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I:I LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <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 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 4 HOUR ADVANCE N TI E REQUIRED FOR INSPECTIONS-PLEA E CALL(20.9)953-7697 <br /> SIGNED TITLE Pl"'Oj• DATE "I - 24) Z I <br /> ------------------- <br /> --- ---___------------------------- ...-___ <br /> f <br /> �p•: r ill� � Ic�T� TY! L9!' <br /> i <br /> 8 n.r 44� <br /> SEP 2021 <br /> p. $T ryI a L SAN JOA N <br /> ` I I ENVIRONMENT COUNTY <br /> D. LJ EALTH D PATL <br /> L- ffiI <br /> rraau' '•nc rac, e <br /> a15-��0-M $ k SAR4Mr FJW fIRYS,u[ <br /> - SUKCNr AtlN lIRA1((C i O.N 10r0-�OS51! <br /> DEPA R TMEN T-LIS.E OA&LY <br /> Application Accepted B Date ?-/ Area / Employee ID# /V 1 <br /> Final Inspection By Date ❑ SP CIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC R c ved Check#/ Amount aPermit/ Invoice# Permit ID# <br /> Code INFO Remitted t Service Request# <br /> IZ -5-23 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />