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ti <br />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 (;ALL 109 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Ile`!/UA <br />-q ADDRESS � �� �.✓ � S f •S CITY/ZIP V W7l c<i �l d <br />CROSS STREET ire, Sr✓I • I APN„rte 5 �'3 �, a 3 PARCEL SIZE <br />OWNER NAME Yc, mclrGi 3 -f; rvu rb V Q t OYJ Yl PHONE <br />OWNER ADDRESS &', M E CITY/STATE/ZIP <br />CONTRACTOR Y 1 t 14zX jA GCA< ( a G/ Y� �� PHONE <br />CONTRACTOR ADDRESS _I 0 >c CITY/STATE/ZIP <br />LICENSE 110C-42 ❑0C-36 OTHER—A NUMBERSPOf555HEXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: t/IEsIDENCE ❑ COMMERCIAL❑ OTHER <br />3 <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: . NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />❑ LIFTSTATION <br />a LEACH LINES <br />❑ FILTER BED <br />13 MOUNDED <br />& SUMPS <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACHING CHAMBERS I# <br />OF LINES I LENGTH OF LINES '"(tS ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION �6� ft PROPERTY LINE %S + ft <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNtD,ATYN ft PROPEERJY LINE? ft <br />WIDTH ft LENG H <br />ft DEPTH �� 10 ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION 4.0 � 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 />DEPARTMENT U E ONLY <br />Application Accepted By �� Date -3 F o-7 1 Area S Employee <br />Final Inspection By Date 22 ZZ Ll SPECIAL PERMIT - Approv E�I1+ <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: �TT <br />COMMENTS Oyir./Iff >1 17f'C - ;Pr :Ir Ivo pefmj) ori (,Te. AsI�G <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />he <br />ash <br />Amount Permit/ <br />Remitted Date Service Request # Invoice #jC <br />OfF # <br />L1,310 <br />)1 s <br />$30 y <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />