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.17 <br /> ONSITE WASTEWA7*'TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMLNTL`- 304 E WEBER AVE-3-FL-STOCKTON CA S _ - (209)468-3420 <br /> w NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOR ADDRESS 1. t,eat CITVIZIP <br /> It CROSS STREET APN V 7 1 q 6 - ?LD PARCEL SIZE � <br /> Limbo y <br /> OWNER NAME PHONE <br /> OWNER ADDRESS �C'"A A— CITY/STATE/ZIP <br /> , { CONTRACTOR I toG K-7 - se-f Vt r-9-- PHONE <br /> w CONTRACTOR ADDRESS Igor. CITYISTATEJZIP C <br /> LICENSE ❑C-42 ❑C-36 OTHFR VF NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> [] PERC TEST # BUILDING PERMIT# 6 a 3 LAND USE APPLICATION# e <br /> 'TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNEDIALTERNATIVE { <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: REsiuENCE ❑ COMMERCIAL ❑ OTHER v <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NHMBEROFEMPLOYEES; <br /> SEPTIC TANK TYPEIMFGPd"L.. _ CAPACITY 0- is gat NOF COMPARTMENTS <br /> JI ❑ GREASETRAP TYPE/MFG CAPACITY. gal #OF COMPARTMENTS <br /> F i ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL D Gft FOUNDATION 0 ft PROPERTY LIN£ S 1 fl ' <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i 'y <br /> _ iCf LEACH LINES Q LEACHING CHAMBERS y, #aF LINES 3 LENGTH OF LINES 401 ft <br /> J DISTANCE TO NEAREST WELL ! a0 1 R FOUNDATION R�I tl PROPERTYLINE <br /> r. ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> { DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPEkTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOONDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH fl DEPTH ft <br /> i- DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> w DISTANCETONEARESr WELL ft FOUNDATION ft PROPERTY ILINE <br /> R"SEEPACE PITS NUMBER - W.TH H DEPTH ft <br /> I DISTANCE TO NEAREST WELL A�_A FOUNDATION_601 ft PROPERTY LINE--_fl <br /> 1 HEREBY CERTIFY THAT l HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RALES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> r..y MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> f I SIGNED TITLE DATE 14 ff <br /> � 64 <br /> sr <br /> f �1 <br /> Li} <br /> A i � ifs <br /> I .a7 <br /> I r <br /> 1111 A& <br /> S N a L <br /> P H D T EN <br /> 1 DEPARTMENT US ONLY <br /> r Application Accepted By d Area af�E_ Employee ID# 1 <br /> I t�--��--.— <br /> > a + Final Inspection By Date d ❑ SPECIAL PERMIT-Appraved try <br /> Character of Soil to D/pth of 3 Ft: J Pit/Sump Soil Character: <br /> COMMENTS^4w/ <br /> Fl <br /> PE SC Received et Amount ate Permit! Invoice# Permit IDN <br /> i Cade lnro B ash Remitted _Service Re uest# <br /> ONSITE WASTEWATER PERMIT <br /> 1 42-02-001 <br /> 1212212003 <br />