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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> MON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS I:97-OZ> -f 12.35"0 S•. tteivr::� F-D • CrrYYrzIP 7ESGr`3't�oN �lS320 y <br /> CROSS STREET 7 I w�/ d APN Z 2-1-ZWO"-f 't""3 C) PARCEL SIZE ' IA-C' m <br /> OWNER NAME /JDrt'11,4nJ 66-r [r A o--TC7/v PHONE ��Q <br /> OWNER ADDRESS O-o,t3o-� �O ZT CITY/STATE/ZI <br /> P <br /> ,/SGS CL dCrhyrI-W41D lb,CA q <br /> CONTRACTOR NV,FO//�1=- �sEOGp�J�+��dt�'1 ENi�'C� PHONE <br /> CONTRACTOR ADDRESS -T O W• �Y�1� �• CITYISTATEIMP �✓( �� �'i'� <br /> LICENSE CC-42 CIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION## PA—I,'- <br /> TYPE <br /> -TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 0 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 TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ 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 It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <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 ft 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 WELL ft FOUNDATION ft PROPERTY LINE It <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 /> MIN1ISA 4 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 p' <br /> SIGNED I w.. TITLE COIZ V LT-At-'17 ATE ME®Oy' <br /> CEI ,VE`® <br /> i PpRCE�L <br /> PARCEL"2" <br /> ^2" � G O V ao IV <br /> V <br /> j AQUIN COUNTY <br /> a RONMENTAL <br /> DEPARTMENT <br /> � i a <br /> PARCEL-a- d� <br /> i <br /> PARCEL"3 <br /> e.� <br /> c t <br /> Ak <br /> Application Accepted By �W•• Date � i,; i�'ril n Area !QEmployee ID# A <br /> I v <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> • <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re est# <br /> X222 1. 6 �. 8-ta-d ` Lo <br /> v <br /> 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />