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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAW STREET-STOCKTON CA 95202-(209)4663420 <br /> NON-REFUNDABBLE'PERMIT 'l CALL 209�95 -7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED f <br /> JOBADDRES9,� JD/ IV. CtTYIZIPZ Z 4 <br /> d <br /> CROSS STREET J ! Pte!'• APN dry? - 0O Uea� — 16 PARCEL SZE e <br /> OWNER NAME •�LSC/%�1 -n kL --7 /j PHONE <br /> OWNER ADDRESS�_2Q` �- 1�,d S �G�C CITYISTATEILIP �,`�t <br /> CONTRACTOR J L PHONE�f ?m a'/ <br /> CONTRACTOR ADDRESS /6 SV CITYISTATEMP 01d C? <br /> LICENSE ''.,]C.42 QC-36 OTHER NUMaER EXPIRATION DATE 7 '•-�' <br /> WATER TABLE DEPTH: Zs-' ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# —0 Z3 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION J REPARIADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: .RESIDENCE Cl COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS' �pj NUMBER OF BEDROOMS: 3 NUMBEROF EMPLOYEES: <br /> O SEPTIC TANK TYPE/MFG&LCAPACITY ZOO gal #OF COMPARTMENTS <br /> Q GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DEITANCETONEAREST: WELL SO YIAr.�� ft FOUNDATION It PROPERTY LINE It <br /> Q LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �. <br /> i <br /> LEACH LINES K LEACHING CHAMBERS #OFLINES _ LENGTH OF LINES_-_ _ft Q <br /> DISTANCE To NEAREST WELL $'0 rk c..ft FOUNDATION ft PROPERTY LINE It <br /> 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> O MOUNDED WIDTH ft LENGTH ft DEPTH ft 6 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> !. SUMPS C,3� WIDTH-2_A 12 W- ft LENGTH J.Z ft DEPTH /0 It _C <br /> t ` DISTANCE TO NEAREST WELL 1 00-&,,, ft FOUNDATION It PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> • DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 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 24 H R ANCOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL( )953.7697 <br /> SIGNED TITLE T ct' DATE <br /> 1 <br /> � I I <br /> � L <br /> all <br /> I <br /> Q1 C U <br /> J <br /> V. i F LT I 0' E JT <br /> N � <br /> lilt /Icy <br /> I i N; <br /> v r <br /> I <br /> ..DEPARTMENT U ON !`v`_IC <br /> y. Application Acca Date O ?.� 0 Area Employee ID# Jr� <br /> Final Inspection Date 4 G L SPECIAL PERMIT-Approved I <br /> Character of Soil to �pth of 3 Ft: pi"ump Soli Character: <br /> COMMENTS LC-DT OJ- P -COA J <br /> PE SC I Received hec Amount ParmiU--_-_-_ Invoice# PermitID# <br /> Coda INFO B Cash itted Data Service oast# <br /> • yZt3 Sv•o t7 S400ss- Zo <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT .4 <br /> 1 <br /> 0/107 <br />