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fpa 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 CALL(�2�0/9)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS�C ! l - Yd�12 ICtX. �,Fq CITY21P LA 'I <br /> CROSS STREETAPN LJC) I—(L"C� - % PARCEL SIZE <br /> OWNER NAME SO Lim( PHONE 4 <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR �eyi fi2�(, ��l/ .� �iiJ�t' PHONE <br /> CONTRACTOR ADDRESS CITYISTATE21P <br /> LICENSE KC-42 ❑C-36 OTHER NUMBER VS96)j/�- EXPIRATIONDATE 67--SI-/0 I <br /> I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O2 AND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION C' REPAIR/ADDITION n ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: b� RESIDENCE _ COMMERCIAL ❑ OTHER I <br /> LNUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: y NUMBER OF EMPLOYEES: <br /> 5t SEPTIC TANK TYPE/MFG 5; „� CAPACITY LG_41a gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS �} <br /> DISTANCE To NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft 1 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> W <br /> El LEACH LINES LEACHING CHAMBERS ?n #OF LINES 7— LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL /S'O' ft FOUNDATION yO ft PROPERTY LINE /O^J <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft Vim' <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft 1k, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ___ ft Iv <br /> 15�- SEEPAGE PITS NUMBER WIDTH " _ft DEPTH �2$­ ft <br /> DISTANCE TO NEAREST WELL :'t ft FOUNDATIONobl00 ft PROPERTY LINE�GYl <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> -PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> i <br /> Rik <br /> - <br /> I <br /> J <br /> R I <br /> r <br /> La��CDEPARTMENT U E LY ,'!! <br /> Application Accepts Date Og Area Employee lD# <br /> Final Inspection B Date /l� � _ L SPECIAL PERMIT-Approved by <br /> Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS D-,J -dT OF r42,lE C-oa­2 ' <br /> ��CPESCReceived Amount Date Permit/ Invoice# Permit ID# <br /> B as emitted Service Retuest#4S D, Sb.eT� -- <br /> 1 _ <br />