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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 209 953-7697FORINSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4j G ! CITY21P <br /> R <br /> CROSS STREET O Pjqlro1 S APN C)g3 D3 z)7a PARCEL SIZE p <br /> O <br /> OWNER NAME 5" J/ y�T_ PHONE <br /> OWNER ADDRESS CITYISTATE21P 'y, � 1'7 <br /> CONTRACTOR �N 1 Vu C PHONE y—('�9- -5-0-2 7 G <br /> CONTRACTOR ADDRESS 379169 �-�f�C'T /"�lw r✓/•� �v� CITY/STATE/ZIP <br /> LICENSE I)-C42 ''1 C-36 OTHER NUMBER Y�9o'lS EXPIRATION DATE heL.?3 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: IX NEW INSTALLATION REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE C COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ' NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG / 9 CAPACITY �j,(}U gal #OF COMPARTMENTS <br /> O GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS y _ <br /> DISTANCE TO NEAREST: WELL O/ ft FOUNDATION ZO / it PROPERTY LINE b ' ft <br /> ,O/LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> q( LEACH LINES LEACHING CHAMBERS #OF LINES J LENGTH OF LINES t7 S ft <br /> r / <br /> DISTANCE TO NEAREST WELL ISo � /(t FOUNDATION �O ft PROPERTY LINE �� ft <br /> O FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> O MOUNDED WIDTH It LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL (t FOUNDATION ft PROPERTY LINE it <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH it LENGTH R DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft (FOUNDATION ft PROPERTY LINE ft <br /> 6� SEEPAGE PITS NUMBER_ 3 1 WIDTH T��/ R DEPTH o�J�/ fl <br /> / DISTANCE TO NEAREST WELL­/SO 1 ft FOUNDATION ZO r ft PROPERTY LINE /O 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9953-7769 7 <br /> SIGNED TITLE ie�f/.�� DATE <br /> IL <br /> I if <br /> / DEPARTMENT U E ONLY �� �(}� <br /> Application Accepted By GL� Date R Area '1/'7-/ Employee ID# m S <br /> �Z rL ❑ SPECIAL PERMIT-Approved b <br /> Final Inspection By {`n�nl,.S� �evt.g0. Date p Y <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS /JevJ SM, Tor T <br /> PE SC Received heck#/ Amount *Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> 14; i(-1 <br /> i <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />