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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAN STREET-STOCKTON CA 95202-(209)4663420 <br /> NON-REFUNDABLE PERMIT /CALL(209 953-7697 FOR INSPECTIONS .r EXPIRES'I YEAR FROM DATE ISSUED <br /> Jos ADDRESS 5-0`100 S . 1„D JZD. 1CmmP ` RTtc"j <br /> CROi4 STREET D V�I•y A\/ <br /> __Ap _ APN 2-39 r 0—O� o4 GPAR,SIZE �� �• O <br /> OWNER NAME c e1%iiLL +-j`C�\,/_!''�[—f=^-A PHONE O�(�—/��p�G zS F <br /> `- DINNER ADDRESS T -1 S BW�'�'t'T J �� CnYISTATE21P � • C A <br /> CONTRACTOR L.1Vt✓. pA.1�'.tC�oc-NVICPA,F 6ey I AL- PHONE 3 t9ji`03,2 5-- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS 'i-0+ - O'N r • CrrY1STATrg, <br /> LICENSE 5C-42 [1036 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# '•� <br /> TYPE OF WORK: D NEW INSTALLATION C REPAIR/ADDRION C ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT C DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY 981 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gat #OF COMPARTMENTS <br /> DISTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <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 It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY UNE 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 /> M IMUM 4 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 p _ <br /> SIGNED TITLE C CNSVL-;FP%N 1 DATE <br /> l <br /> PPyM�v <br /> MPS 31 <br /> 1� <br /> PQv��N�p1.N� DEPARTMENT SE L� 1d <br /> SPN J0,>�QM pa't1 rCabon Accepted B - Area Employee ,� <br /> EN N Q�P Final Inspection By Date 0 SPECIAL PERMtr-Approved by <br /> Character of Soil to Depth of 3 Ft PittSump Soil Character. <br /> COMMENTS <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted So-ice Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10/4107 <br />