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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CC22 CALLT(2��09�} 953-7697 FOR INSPECTIONS EXPI <br /> RE <br /> S <br /> 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS ��� S. R4>. E CrIT�YZP 5'RJC�KTa7J y <br /> CROSS STREET S9 l�ri L.Ey APN 1'r <br /> CROSS TO-ts PARCEL$QE 3I"fv y� <br /> • �n <br /> OWNER NAME EMILY-y M&Oce-Tv <br /> PHONE 9-2-3Z4+eT P <br /> OWNERADDRESS ZZy-I AJ. UNION 1�--1,�. BIZ CRY/STATF/LP rnnA/fFGF1+ C-A '9S336 <br /> CONTRACTOR l- IX�oAje- G6NEMYtL W <br /> &-0E:P\Al2- mPHONE 3(Df-n031,T- <br /> CONTRACTORAODRESS TAT W' 0&w— Si-, CITY(STATE/ZIP V..al C6'1' RS2wa <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPAHUADOmON ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WI LL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OPCOMPARTMENTS <br /> DIBTANLE'TONEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFTSTATION SRE TYPE OF PUMPC1.PKGTX PLANT ❑ SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTHOFLINES ft desa.L�^y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ••/ ¢.� <br /> E3FILTER BED WIDTH ft LENGTH ft DEPTH It {.r���D <br /> DISTANCE TO NEAREST WELL If FOUNDATION ft PROPERTY LINE—� <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPOT O �O/8 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE�y�fl <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH QUIN <br /> DISTANCE To NEAREST WELL If FOUNDATION it PROPERTY LINE CA T <br /> C3DISPOSAL PONDS WDTH ft LENGTH ft DEPTH -"l6'1 FPgR7q� <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft MFNT <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH If <br /> • DISTANCE TO NEAREST WELL it 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 /> ��✓�j✓�1I�I IMUM� UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED J� TITLE GL NSVLT/T1V'T' DATE <br /> MOBIEY Am <br /> 1 • � I <br /> 10 <br /> ¢am ion i �¢unun m <br /> -_J <br /> L <br /> e c _ J <br /> „¢ V12 5 j <br /> N PNm] <br /> I� I <br /> DEPARTMENT USE ONLY,/ / <br /> Application At cepted By Date �S- - JJ Area Inti, Employee 10# toe,",`7 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Solt to Depth of 3 FD PU/Sump Solt Character: <br /> COMMENTS <br /> • PE SC Reeeivetl Amount Data Perm1U Invoice# Permit ID# <br /> Code <br /> INFO B Cash Remkted Service Re oast# <br /> -7 <br /> 42-01 ONSRE WASTEWATER TRTMNT SYSTEM PERMIT <br />