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r'< ONSITE WAS`"WATER TREATMENT SYST` l PERMIT <br /> COUNTY ENVIRONMENTAL HEALTH.DEMRTMENT- 600 E MAIN jTREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PE}RMI,T• ' CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J09 ADDRESS t +x `'� U i ,i"� CITYIzIPe 14 ��S b <br /> fm <br /> C- <br /> f CROSS STREET ` -J Lr� \` / APN o�s� G-50 <br /> Il <br /> ,OWNER NAME 1 A 'i �P�HO,NE ELE y <br /> OWNER ADDRESS ! / a + t � 6CITYISTATEfZZIP <br /> CONTRACTOR PHONE. y <br /> CONTRACTOR ADDRESS '4 it l'r F CITYISTATE/ZIP ck\ I*C.0 tr C �j �� S v <br /> rLICENSE ❑C42 ❑C-36 OTHER r NUMBER � 'I7 2 EXPIRATION DATE § — C' <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 07 3"Y LAND USE APPLICATION# <br /> i <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNEDlALTERNATlVE <br /> 11 REPLACEMENT © DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL O OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 0 7`+ NUMBER OF EMPLOYEES: <br /> C SEPTIC TANK TYPE/MFG - G AP= 1&00 gal #OF COMPARTMENTS <br /> I ❑ GREASE TRAP TYPE;/MFG CAPACITY gai #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL e�l c"* ft FOUNDATION ft PROPERTY LINE ft <br /> 13 LIFT STATION SIZE TYPE OF P P ❑ PKG TX PLANT SAND OIL SEPARATOR(EILOS SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES r S LENGTH OF LINES l� ft <br /> ' DISTANCE TO NEAREST WELL /M —a�-- ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft N <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft , <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft r <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH f4= <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 /> i ✓ MI DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 (, <br /> SIGNED TITLEDATE �� <br /> I <br /> 's I ax <br /> CCU" <br /> p nNVFN <br /> rJ DEPARTMENT USg ONLY <br /> Application Accepted Date 3 acs Area Employee ID# L( <br /> Final Inspection Byate ElSPECIAL PERMIT-Approved by <br /> Character of Soil to 0epth of 3 Ft: it/Sump Soil Character: <br /> C0M NT AjE.r_.j 4-o-, 0�7-- C_.0 a-/-1 .S'�i)g <br /> S lr e. Sj <br /> 11-71 g4 <br /> PE SC Received heck#! Anfount ZI Date Permit! 144 <br /> Invoice# Permi <br /> Code INFO B ash Remitted Service Request# <br /> 42- 11 117 55-77C `fes D,CW &WO's 14 Lf S-0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />