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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SANJOAQUIN 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 <br />iEXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS Z:q 19 '- nG CIA,(? CITY/ZIP qtb" \CLLoll 11 J -� 3 <br />CROSS STREET /,4q,,-p.tD/4^1 APN 11i– 100-0` PARCEL <br />PARCEL SIZE <br />OWNER NAME J. C_ Mgky-C K(50+[; PHONE (29 <br />cLra <br />!A�S-S; <br />OWNER ADDRESS F-i-eA A 4014 CITY/STATE/ZIP �11 <br />'bC0" e -A <br />CONTRACTOR 7H -4"I <br />CONTRACTOR ADDRESS CITY/STATE/ZIP 1-0 3, <br />G, �J J <br />LICENSE ❑OC -42 ❑OC -36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT# LAND USE APPLICATION # % <br />TYPE OF WORK: D NEW INSTALLATION 0 REPAIR/ADDITION -I ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT F1 OUT-OFSERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: F1 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY 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 />❑ LEACH LINES <br />i i LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE fl <br />❑ MOUNDED <br />WIDTH <br />It <br />LENGTH <br />R <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />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 />I I .-.--- I " 1 711 Date I _ . " _... 1 Invoice # I Permit ID# I <br />Ar <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 <br />F— F— <br />C -'j 0 H <br />Z <br />C= zea <br />LU <br />CC-) 05= <br />J ' z <br />zdw <br />/I- <br />42 -01 <br />C <br />