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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1368 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT _ CALL 209853-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/]jp .� <br /> APN CROSS STREET - <br /> p$pC PARCEL SIZE <br /> OWNER NAME 61iel <br /> S Lj/�Z2'0 // PHONE y <br /> OWNER ADDRESS R35 S. G11FJokee G-Ci•nF. CfTY/STATEILP LQdj ySpD,VO NN <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS 3�,I - GZll Clrr/STATEMP -5/4r,46,4- <br /> LICENSE 0)(C-42 00036 OTHER NUMBER YJ S/X k EXPIRATION DATE dy%.� <br /> WATER TABLE DEPTH: -70-7(3 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# djOY116 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 0 REPAIRIADomow ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I:J OUT-OF-SERVICE FERYICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER I t14tt S� <br /> �[ NUMBER OF LIVING UNITS: I <br /> /J NUMBER OF BEDROOMS:_ NUMBER OF MPLOYEES: <br /> [7. SEPTICTANK TYPE/MFG YCAPACITY gal #OFCOMPARTMEMS� <br /> ❑ GREASE TRAP TYPEJMFG T CAPACITY gal #DF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL__/dQ%' ft FOUNDAI"ION 410 ft PROPERTY LINE WJ A <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES I_ LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES k5—' it <br /> DISTANCE TO NEAREST WELL /SO ft FOUNDATION S73 ft PROPERTY UNE_ �SU R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCETO NEAREST WELL ft FOUNDATION fl PROPERTY LINE It <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELLft FOUNDATION fl PROPERTY UNE ft <br /> ❑ SUMPS WIDTH R LENGTH it DEPTH _ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> DISPOSAL PONDS WID7H _ft LENGTH it DEPTH ft <br /> DISTANCE To NEAREST WELLit FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER _I? WIDTHft DEPTH'S , it <br /> DISTANCE TO NEAREST WELL /STi/- it FOUNDATION_ R PROPERTYUNE��� ft <br /> bEREBY CERTIFY THAT I HAVE PREPARED TH 15 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 /> MINI"48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7 <br /> SIGNED TffLE6l 4 DATE <br /> H Al <br /> DEPARTMENT USg ONL <br /> Applic3tion Accepted By Date I Z O � <br /> Z _ Area LI C]% Employee ID# 1` <br /> Final Inspection By 4 -C ro �..,i,� Date 1(7-7/7024 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft, PitlSump Soil Character: <br /> COMMENTS <br /> PE SC Received Etat Amount Date Perm1U Invoice# PermitID# <br /> Code INFO BY Remitted Service R ueat# <br /> L,1;1) 11- s g 12-2 21 <br /> 42-01 ONSITE WASTEWATER TRTNMT SYSTEM PERMIT <br /> 4/14118 <br />