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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468.3420 <br />NON-REFUNDABLE PERMIT CALL (2091953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 1Jt0 ZZ 7�7G5C-I ` 17E�W n USCA -37— <br />I I LEACHING CHAMBERS <br />+�TCITY/ZIP <br />-3" - PARCEL SIZECROSS STREET APN <br />LENGTH OF LINES ft <br />_5 <br />OWNER NAME JANCT MLLE�19p(L'Y RU-JONY PHONE G`J7vgj <br />DISTANCE To NEAREST WELL <br />.3•Q� <br />OWNERADDRESSz-Lecr�• 4CIN/STATE/ZIPV C^W� CA ' KI <br />It PROPERTY LINE ft <br />CONTRACTOR L4%IE- () FK— PHONE A91- 0 335 - <br />WIDTH ft LENGTH <br />CONTRACTOR ADDRESS40-4-W. OAK- CIN/STATE/ZIP Lo-) I CA -17-4 o <br />ft DEPTH ft <br />LICENSE _-IC-42 LIC -36 OTHER NUMBER EXPIRATION DATE <br />DISTANCE TO NEAREST WELL <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # i <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAWADDITION ❑ ENGINEER DE16IGNED /AL ERNATIVE <br />-, REPLACEMENT _. DESTRUCTION <br />INSTALLATION WILL SERVE: I I RESIDENCE _I COMMERCIAL I OTHER <br />ft DEPTH ft <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />DISTANCE TO NEAREST WELL <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 WELL <br />ft FOUNDATION <br />It PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST 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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />INIMU 2�OUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - <br />PLEASE CALL (209) 953-7697 <br />SIGNED <br />/ " <br />TITLE C OW50(jW-%r <br />DATE <br />NOUIIyC•v <br />TN�R.NtipUN1YE, <br />` EPARTMEN Mall (�N <br />Application Accepted By / Date :j0 AreaEmployee ID# <br />Final Inspection By W iG Date El SPE&IALRMIT - Approved by <br />Character of Soil *� neoth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS AQrz 3-r} ` YSd' i,2oAl EI-W&o (,tilp" <br />146A,4014845) Pl eGEL a ; 376' E, PAOPEAV l-1lJE AJJ Sa of S, �6DFR� r <br />L,JF . PAA X -J— 1.- 02 70" E P/LoPERTy Linlr qjb Se' 4 vF s. P,CdAA y <br />PE I SC Received Chec Amount Permit/ <br />Date Invoice# Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />