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ONSITE WASTEWATER TREATM, i SYSTEM PERMIT <br /> SAN JOAQUIN COUNT(ENVIRONMENTAL HEALTH'DEPARTMENT - 600 E MAIN STREET-STOCKTON CA 85202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES/1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS G > 'F•-i'lC 12 A CtTY2W i d'-r i� `l �.`.?5 .7..__ `w <br /> F �y <br /> CROSS STREET E 1 sty,1S f i �(, _- _ APN f '"'C/t��i — PARCELS. �. p <br /> ;• <br /> OWNER NAME �;7C_ 4 ��I"'-�Cti l •`-�'?i/ti __._ _PHONE _-- <br /> OWNER ADDREB8 f ^�v� r l I z.'�'tv�`i �1 i°I,-t _ CITYISTATEMP <br /> C. <br /> CONTRACTOR L..,I\ f ,'C` €�.+FC�'f%1�w a l.iY�lv'Yw��ri f t� -PHONE •"- // <br /> CONTRACTOR ADDRESS r.I(,�! �,✓, (•)i� ��t CITr1STATEMP <br /> LICENSE C]C-42 QC-36 OTHER NUMBER ExPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFOFwATtow Coordinates X Y <br /> fR, PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 173 NEW INSTALLATION ❑ REPAIRIADDITHM © ENGINEER DESIGNED IALTERNATIVE <br /> O REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: IJ RESIDENCE ❑ COMMERCIAL Q OTHER <br /> NUMBER OF LFvri UNITS: NUMBER OF BEDROOMS: NUNBER OF EMPLOYEES: <br /> 11 SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 0 GREASE TRAP TYPE/MFG CAPACriY gel #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CI LIFTSTATION SIZE TYPE OF PUMP 0 PKGTXPLANT 17 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> C1 LEACH LINES G LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> 1.1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CI FILTERBED MUTH ft LENGTH ft DEPTH ft <br /> DISTAwm TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O MOUNDED WIDTH k LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE fl <br /> O SUMPS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft 'I' <br /> 0 DISPOSAL PONDS wIDTN ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WEST ft FOUNDATION ft PROPERTY LINE it <br /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS/PLEASiEf CALL(209)953-76971 � <br /> SIGNED f i# TITLE { /�.:f..l\„_j,.,� '.�y[ il J4=\� DATE <br /> .._. <br /> .Ax, <br /> S ti i �• 14 <br /> 49 <br /> E i p M <br /> 1•'` DEPARTMENT USE ONLY <br /> 1NT <br /> { f <br /> Application Accepted By Date�L/f r i l) Area Employee ID# <br /> Final Inspection By Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump"I Character: <br /> COMMENTS <br /> PE $C Received Gheck#! Amount Date Permit/ Invoice# Permit IDD <br /> Code INFO B fi Remitted Service Re Uest# <br /> 42.111 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> SrAmo <br />