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NSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> _ SAN JO tN COUNTY rONM ENTAL HEALTH DEPARTMENT 300 BER AVE-3N°FL-STOCKTON CA 9$202 - (209)468.3420 <br /> N -REFUNDABLE=. RMIT CALL(209)953-7697 FOR INSPEC.- s XPIRES 1 YEAR FROM DATE-t@@reEB <br /> in <br /> JOB AoDRESs CITYIZIP C' <br /> CROSSSTREET APN 6}2r (920-Ot/ PARCELSIZE 4C _ n <br /> - OWNER NAME <br /> {$^- OWNERADDRESS CITYISTATEIZIP R <br /> i-F CONTRACTOR - -7- 3&:P <br /> PHONE <br /> ✓�.. L_y'3&:P <br /> CONTRACTOR ADDRESS CITYISTATF/ZIP <br /> LICENSE 42 ❑C-36 OTHER NUMBER Z4s EXPIRATION DATE d O G <br /> - WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y , <br /> . - Q PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> - _ - TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION Q ENGINEER DESIGNEDIALTERNATIVE f <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> ( <br /> INSTALLATION WILL SERVE; ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> - NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS; NUMBEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> _ ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION A PROPERTY LINE It <br /> ❑ LIFT STATION SIZE Type OF PUMP Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �� fl <br /> - BLEACH LINES JGI,��rr�LEACHINC CHAMBERS � #OF LINES LENGTH OF LINES �7 <br /> DISTANCE TO NEAREST WELL 1 —R FOUNDATION fl PROPERTY LINE V R <br /> Q FILTER BED WIDTH fl LENGTH ft DEPTH R <br /> ['^ DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE A <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE n <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R + <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH _ ft LE R DEPTH R <br /> DISTANC£TONEAREST WELL ft FOUNDATION /09:? _R PROPERTY LINE 11 1 <br /> I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUfN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPE IONS-PLEASE CALL(209)953-7fi97 <br /> ,�'�� � It2,42 <br /> LE�Oi/ ITLE DATE <br /> i <br /> i <br /> 1 1- <br /> I I <br /> s <br /> F; <br /> fff <br /> G <br /> DEPARTM NT PSE ONLY <br /> _ Application Acce Dale -3 �3 Area -24-2 Employee ID# <br /> - Final Inspection DHe3� ❑ SPEC! PEe�J„ RMITIT--AApprovedby <br /> Character of Soil to Depth 3 Ft: PillSump Soil Character: <br /> CO ENTS -o 4zr tL7e! eQ�G. II •tc of [!Cs) <br /> PE SC Received et ! 'Amount Per-" ` <br /> - } - Cade INFO B sh Pmiued Date Service Re oast# n e 't # <br /> fix.j (ev.crt) 1 <br /> 42-01.001 <br /> ONSITE WASTEWATER PERMIT <br /> 122!02 <br />