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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 ip C-CAALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ( JOB ADDRESS 11 3 Z S W. VI pll Plt:'- CITY/ZIP ''19,36ao 4 (� L <br /> Cl l- <br /> CROSS STREET G ftv"Opj APN Z-)Z• 6 PARCELSIZE O•7� p <br /> D <br /> *Iw <br /> Q 3A 7 � r 0 ` � 3O-OWNER NAME <br /> T� AAmA c^Q9453C <br /> OWNER ADDRESS YTK <br /> CONTRACTOR LIVI Of\omGi0C4QV)'pVN Al 1-7vTPVL <br /> y <br /> Ai <br /> PHONE 3(pl-o3 lS 'J <br /> CONTRACTOR ADDRESS w Q r`F S I CITY/STATE/ZIP L0-1,>1 Q( CA 1 �11 c� <br /> LICENSE I.IC-42 1--'C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> tK PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: i NEW INSTALLATION .. REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT II DESTRUCTION <br /> INSTALLATION WILL SERVE: 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 It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <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 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 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 2 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE LO�S�L-1 Ah/T DATE <br /> YM47 <br /> E�VFD <br /> 132019 <br /> MRNTNjY <br /> SENT <br /> IIFL <br /> D ARTME US LApplication Accepted Area Employee I <br /> Final Inspection By Date OZ . IAL PERMIT-Approved byCharacter of Soil Depth oWO' <br /> Pit/Sump SPil Character: <br /> COMMENTS 1, K'loza sU/Q r S f i✓1C�l. <br /> PE Sc Received Check Amount Permit/ <br /> Code I Fo B mitted Date Service Re uest# Invoice# Permit ID# <br /> v 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />