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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 /> 4 <br /> NON-REFUNDARI F ZZ PFRMIT CAI/ 1209)953.Z697 FOR INSPECTIONS EX IRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 Z✓! fl f-r LPL. _CrrvrzlP I' y <br /> CROSS STREET��Jrj�y!/ //���L APN 0"1` "-ll -(0 d PARCEL SIZE 9. 7-3n a <br /> OWNER NAME �C. . zzr%G, Salvador PHONE L <br /> OWNER ADDRESS �.a B0 X 1 l CrfY/STATEIZIP�QL i n1d en i A 9 5 a 3 <br /> CONTRACTOR stir lafN�� G-- PHONE 2�` <br /> CONTRACTOR ADDRESS /d.?!l �'JL�1/J�J ��N Crry/STATEIZIP_ <br /> LICENSE �:C:-42 ❑i.'.C-36 OTHER NUMBERJ_DT EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION EPAIR/ADDITION a ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG -60X4- ,� CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Jer—LEACH LINES C LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLW t ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It 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 PROPERTYLINE 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 /> A—SEEPAGE PITS NUMBER WIDT� ft DEPTH 2� ft <br /> DISTANCE TO EAREST WELL_/jaQe,, ft FOUNDATION JA 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 /> MINIW9448 HOUR AaANCEAOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE & <br /> J � <br /> o <br /> m <br /> m3 <br /> < m <br /> Aw 0 0Z <br /> /��� DEPARTMENT USE ON Y �_Application Accepted y � __ Date -1 Z Area 4 q Employee ID# <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3If-. US p oil Character: <br /> COMMENTS��/Z�✓/'r�flS y� � N' �`�'y� L�� �N • <br /> PE SC Received Check#I Amount Perm"' <br /> Code INFO Cash emitted Date Service Re uest# Invoice# Permit ID# <br /> 2�b ��� 3y� •? 1 �` <br /> 42-01 V. <br /> R11U YS� A c c e I a <br /> 4/14/18 <br />