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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> P � <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLEPERMIT <br /> +A CALL/ 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I` jor", ;e f x N CITY/ZIP clry aC• qq)'S Q <br /> Pr G 14�0�' 3�r 7 y a <br /> CROSS STREET L �� APN ` PARCEL SIZE W <br /> n d <br /> OWNER NAME R <br /> g��� l�'no �- fM�{O Va I er p�opt'�kr L�G PHONE n <br /> OWNER ADDRESS b71) Z I P CITY/STATE/ZIP /��' ✓� <br /> CONTRACTOR f-'V bre R�41,f o t. PHONE q`J f- Y) y tl�� l <br /> CONTRACTOR ADDRESS -16 Yo IVi'k/®i"c driA CITY/STATE/ZIP c('Cef..ao'i L5 qt <br /> LICENSE ❑❑C-42 ❑1 6-36 OTHER NUMBER [ 3 " '09 9 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFO MATION: CoO dinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O AND USE APPLICATION# <br /> TYPE OF WORK: u NEW INSTALLATION L R AIR/ADDITION u ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 S n CAPACITY o 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 P ANT ❑ PAN OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES - ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 /> MI IMU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED- TITLE Sfi�f�i✓1�P��C?✓1 DATE <br /> J A T <br /> N p <br /> �DCOARTMENTUSEOPLA <br /> Application Accepted By Date Area Employee ID#� <br /> Final Inspection By Date / ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Z« <br /> J <br /> PE 'SC Received III"Check#P Amount Permit/ <br /> Code INFO B emitted D Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />