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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 G /JCALL 209)953-7697 FOR INSPECTIONS { ` EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS Z 3 �'/} N r �L r� • CITY/ZIP tel.A-K'k 1 0 9S-2-2-0 <br /> CROSS STREET •r`''N' APN 0 �� PARCEL SIZE � <br /> ` (p Ac• p <br /> Q <br /> OWNER NAME A 1 VEL-- PATI N O PHONE <br /> OWNER ADDRESS S^MC CITY/STATE/ZIP <br /> Z <br /> L-1 CONTRACTOR VI OAK- GENNNW4 <br /> DEV, + EI�� J <br /> PHONE (p1C <br /> - �r3 <br /> CONTRACTOR ADDRESS T"--V -J- C)�- �T• CITYISTATEIZIP L-- pt <br /> ( <br /> LICENSE 1 iC-42 'C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _ REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> I: REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: D RESIDENCE I I COMMERCIAL I 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 It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES _ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 /> MINIM 'M`2 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 A <br /> SIGNED I``- TITLE C07J$VLII�NT DATE I- L-1� <br /> J4* <br /> 01 <br /> F 0,qf9 <br /> 0& <br /> MFNT <br /> DEPARTMENT U E ONLY J <br /> Application Accepted By Ehr'� Date I Z 01q Area Employee ID# <br /> Final Inspection By Date 26fj SPECIAL PERMIT-Approved by <br /> Character of Soil to De of t: Pit/ ump Soil Character: <br /> COMMENTS FA - Ci0 LC-5 <br /> arc cRe, 2 5 vru 1 ifl S to vv 7-'J o <br /> PE SC Received he Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO asji Remitted Service Re uest# <br /> 42 ZZ \ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />