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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 CALL_(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOS ADDRE6S �'- CITY21P <br /> CROSS STREET 2d^�// / APN O _I—(LCI PARCEL SIZE T' •'-3 a ` <br /> OWNERNAMEJ5PHONE o <br /> D <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR �C� �1_/_ s; \r PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE KC-42 ❑C-36 OTHER NUMBER yS90xl�' EXPIRATIONDATE 67---k)-16 I <br /> I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L PERC TEST # [BUILDING PERMIT# U AND USE APPLICATION# <br /> TYPE OF WORK: K New INSTALLATION ❑ REPAIR/ADwnoN ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALI-ATION WILL SERVE: RESIDENCE ❑ COMMERCuu. 0 OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: U NUMBER OF EMPLOYEES' <br /> Lt SEPTIC TANK TYPE/MFG Gni CAPACITY /Gd0 gal #OF COMPARTMENTS V2 - <br /> 0 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION_ it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> _ L•i <br /> C LEACH LINES 0E-LEACHING CHAMBERS Zn #OF LINES _7 LENGTH OF LINES O ft <br /> DISTANCE TO NEAREST WELL /SV' It FOUNDATION V4' ft PROPERTY UNE <br /> ❑ FILTER BED WIDTH _ft LENGTH it DEPTH it `\ <br /> DISTANCE TO NEAREST WELL it FOUNDATION____ ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION H PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH __ _ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION it PROPERTY LINE __ft U <br /> Cif- SEEPAGE PITS NUMBER WIDTH !! r it DEPTH dS r it <br /> C DISTANCE TO NEAREST WELL _,gQ `F ft FOUNDATION L /Lb ft. PROPERTY LINE_/ - It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED I TITLE l�si .� DATE / s- <br /> j14V" <br /> eri <br /> 10 <br /> A <br /> I r <br /> I <br /> 3A J <br /> R <br /> 7 <br /> DEPARTMENT LIFE LY <br /> Application Accept <br /> _ Date Og Area Employee ID# <br /> Final Inspection B Date l'_ U SPECIAL PERMIT-Approved by <br /> Character of Soil to iWpth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS QC-/ -f OF ,Q.£c:c,'0�9 <br /> bra a7 <br /> PESC Received Amount Date Permit! invoice N Permit IDN <br /> Code INFO By as Remitted Service Request# <br /> 14E-(1-7 <br /> 42-0I - _; ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />