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ONSITE WA1.EWATER TREATMENT SYS".�/W PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MNN STREET-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLEPERMITCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS /S!/Bz- zAL /AlE /ZD CITY/ZIP STOCKY-y. i qt-2-rS <br /> CROSSSTREET [��I�KE�-t� APN �F/l S' 0!1E 3 9' PARCEL SIZE —JOA-c_ rj <br /> OWNER NAME _PHONE 4GG � 586 y <br /> OWNERADDRESS /0092 AWIVE ELF) . CITYISTATEMP l(TdGkTDA/ <br /> CONTRACTOR C.�-/�SN�� �t9eJf I-7-/AJ6 PHONE_& JE-J40� <br /> CONTRACTOR ADDRESS /�j. 0• -�, ox 3 7q-f CITY/STATEZP <br /> LICENSE !�C-42 L.2CJ6 OTHER NUMBER EXPIRATION DATE scAtumn <br /> WATER TABLE DEPTH: ti 3 5- ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # y BUILDING PERMIT# LAND USE APPLICATION# _a <br /> TYPE OF WORK: C NEW INSTALLATION ❑ REPAIRIADDIMON ❑ ENGINEER DESIGNED/ALTERNATIVE 1V <br /> REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO 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 ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> I HEREBY CERTIFY THAT 1 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 /> 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE G A11VE2 DATE I/'Z�-�B <br /> 2 <br /> E Zd2 p <br /> L <br /> E VI 301 4M] NAL <br /> PARTMENT E O <br /> Application Ac PIS ps� Date U� Area Employee ID# �- <br /> Final Inspection ey Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D pth of 3 Ft: PitP§ump Soil Character: <br /> COMMENTS " <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> -Zcl-10 Q 111 a <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10/4/07 <br />