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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS qvq cir CITY/ZIP `_ /)C:j 1 < y <br /> CROSS STREET APN O✓ L/ PARCEL SIZEJ <br /> OWNER NAME T)I? Co �✓ I �L � —PHONE Z <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR Septic Services Group PHONE 916-203-6259 <br /> CONTRACTOR ADDRESS PO BOX 569 CITY/STATE/ZIP Wilton,CA,95693 <br /> LICENSE C-42 -i C-36 OTHER ,A. NUMBER 1068208 EXPIRATION DATE 8-31-2022 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X_ Y <br /> [.; PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT //// ____ <br /> OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL - OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG u Ci CAPACITY I JU_ gal #OF COMPARTMENTS__ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS_ <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13 LEACH LINES LEACHING CHAMBERS #OF LINES -f <br /> LENGTH OF LINES z ft <br /> DISTANCE TO NEAREST WELL 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 It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH_ ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER I WIDTH_ It DEPTH_Z 5 1 ft <br /> DISTANCE TO NEAREST WELL_ R FOUNDAI,0N /UT ft PROPERTYLINE ft <br /> I HEREBY CERTIFY THAT 1 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 ADE NOTICE REQUIRED LEASE CALL(209)953-7697 <br /> SIGNED / TITLE RME DATE�41 <br /> � <br /> S e e I Alt I t I a c h e d D r a w i n g <br /> E7AV�AQU/N <br /> M�Nry <br /> FN7 <br /> -T7--i- <br /> DEPARTMENT USE0 L Y 0� <br /> Application Accepted Date ' Area Employee ID# I <br /> Final Inspection By Datei�l SPECIAL PERMIT- oved y <br /> Character of Soil to De th of3,FJ-. i ump Soil Character: <br /> COMMS TS <br /> CIL C L <br /> PE Sc Received Check#/ Amount Dat Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted rvice Ra uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SVSTEM PERMIT <br /> 4114118 2-1 <br />