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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 tXPIRES l YEAR FROM DATE 1bbUt_ <br />JOB ADDRESS 30&+4 E. jAi W-jarwr I=p• MCRY/ZIP 4�c4kvK o 0)x3.7-0 <br />CROSS STREET &X Ayt A w\ w APN 0 `-' l - 2.10 ^ • 1P PARCEL SIZE 1 ' �� A <br />OWNER NAME A,(&- UI1z0 II -Ey VA PHONE(91lv)g91-rs3i'l <br />OWNER ADDRESS 4' 7-2--4 a '' �L <br />�Cc L- I I'fL � ' CRY/STATE/ZIP *C A-Mp 0 cA It 5'2-2'0 <br />CONTRACTOR L\ V E O PqL (�pgt>,JV V""mEP..J ^L_ PHONE 3(A - C 31 S <br />CONTRACTOR ADDRESS 401 LA.) - 0 A K Srr• CITY/STATE/ZIP "m I CA ev V j.'40 <br />LICENSE C-42 11' C-36 OTHER ` c. &- NUMBER 7-I s _ I EXPIRATION DATE 1+ - 3 V - 7�2 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />)iC PERC TEST # BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPEIMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS__ <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES It <br />DISTANCE TO NEAREST <br />WELL <br />fl FOUNOATION ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />R DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />R DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION It PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />ARM= <br />AQVANCE NOTICE <br />REQUIRED <br />FOR INSPECTIONS - PLE4SE CALL (209) 53-76697 <br />SIGNED <br />OjdQUB <br />TITLE_ P/L V J ' Vk bR • DATE 1. — p. - Z <br />Final Inspection By t- - y „' Date `7 I 1 i � SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />PE SC Received Check Amount Date Permit/ Invoice If Permit ID# <br />Code INFO By Remitted Service Request # <br />'1412 Sa3VF <br />5 2 S <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />)f` <br />