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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT _ 600 E MAIN STREET-STOCKTON CA 95202-(209)488+3420 <br /> 1110N-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS f .. cnyrzjp C' - erA <br /> _ 7 <br /> CROSS STREET �:.+� .'i f.. '{ �. fj - APN :'.a_`i7 /J 70 ---ls Z PARCEL SIZE i � v <br /> OWNER NAME.-.,0Y l {. t: •}F ii�"1�- ,:ti- 'r L. �� r 1` _ /t PHONE <br /> OWNER ADDRESS CITYISTATERJP <br /> CONTRACTOR PHONE - <br /> CONTRACTOR ADDRESS - CITYISTATErZ P <br /> LICENSE QC-42 QC-X OTHER NUMBER EXPIRATION DATE ' <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION' Coordinates X Y <br /> PERC TEST # Y "r+ BUILDING PERMIT# LAND USE APPLICATION# i <br /> TYPE OF WORK: 0 NEW INSTALLATION ❑ REPAWADDmoN ❑ ENGINEER DESIGNED IALTERNATIVE <br /> Q REPLACEMENT u DESTRUCTION <br /> INSTALLATION WILL SERVE., ❑ RESIDENCE I] COMMERCIAL ❑ OTHER <br /> NUMBER OF Lem UNITS. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' <br /> Q SEPTIC TANK TYPF/MFG CAPAcrrY psi #OF COMPARTMENTS <br /> 13 GREASE TRAP TYPEIMFG CAPACITY pal #OF COMPARYMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION It PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Cl LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH fl l <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> 0 MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE R �� <br /> 0 SUMPS Wurn ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> 13 DiSPOSALPONoS Wuml fl LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft '~ <br /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 SMI JOAQUIN COUNTY. _ <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7897 <br /> SIGNED{irTITLE I�'�`,:r.t["._ DATE <br /> rl 2 <br /> a <br /> f. <br /> I f i- <br /> j <br /> I <br /> i <br /> DEPARTMENT USE 041-! /f <br /> Application Accepted BY .'`'--'-'3( ... Date L 4 i �t 10 G] _ Area Employee ID# -�� a�(0 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PkGump Soil Character: <br /> COMMENTS <br /> PE SC ReceivedChecktl/' Amount Da>e PermlV ImraiCe�1 Permit W# I/ <br /> Coria INFO B -..0 fish Remitted Service Meat# <br /> 6201 ONSITE WASTFWATFR TRTMNT SYSTEM PERMIT <br /> +MA N1 <br />