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l OnSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4W3420 <br /> i <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE.ISSUED <br /> Jolt ADDRESS p J 3 PQj'1:5 jj•-l CITY/ZIP /r M IoAf-ef., {Gd L <br /> CROSS STREET APN 2-24: 3 2" PARCEL SIZE <br /> �• <br /> v <br /> OWNER NA.Yu: C� Cr r G P.. C6�.3`&0 a:0 � <br /> OWNER ADDRFSS S L7 IYI'C I� cCTTYISTATEYLIP <br /> 1-1 / 4 <br /> CONTRACTOR F l t t•r S t.7 GLK1oL �cf- PHONE <br /> CONTRACTOR ADDRESS �.A ♦�_ O CITY/STATE/ZIP /•fort f�(Ly/g �,N� <br /> LICENSE O C-42 ❑ C-36 OTHER--h— !NUMBER � EXPIRATION DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> D PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: O NEWINSTALLATION fd' REPAIWADDI•ITON O ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: (RESIDENCE O COMMERCIAL O OTHER <br /> NUNTBEROF LIVING UNITS: --L— _ NUMBER OF BEDROOMS: 3 NLMBER OF FNIPLOYFES: <br /> O SEPTICTANK TYPE/MFG CAPACITY_ gal #OFCOMPART.VE1,7S <br /> O GREASE TRAP TYPF'MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETONEAREST: WEI.I. ft FOUNDATION _ A PROPERTY LIE ft CIO <br /> D LIFT STATION SIZE --TVPEOFPUSIP --- ❑ PKG TX PLANT SAND OIL SEPARATOR(EN SYSTEM) <br /> Y' LEACH LINES U LEACHINCCHAIIBERS iy4 � #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ETDI ft FOUNDATION PROPERTYLLNF. A WI <br /> j ❑ FILTER BED WmTH ft LENGTH —ft DEPTH ft <br /> DISTANCE TO NEAREST WELL T ft FOUNDATION_ ft PROPERTY LME ft <br /> ❑ MOUNDED WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LME ft r <br /> ❑ SUMPS WmTH ft LENGTH- .--ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSALPONDS WmTH ft LENGTH_ _ ft DEPTH It <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SEEPAGE PITS N1111RER WmTH_ _ ft DEPTH fr <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LME ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAW'S AND RULES AND REGI.1"ATIONS OF SAN JOAQUIN COUNTY. <br /> MININIUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9S3-7697 <br /> SIGYF,D_ t -Ot- TITLE r Etn 4-r4>G4-cr DATE a �Af <3$ <br /> —61 <br /> t <br /> r :- <br /> " / T <br /> I •v � <br /> r <br /> Ae <br /> I <br /> t Jtt <br /> DEPARTMENT USE O LV / S/ <br /> Application Accepted Be - C' Area Employee 1D* r t 5 n <br /> Find Inspection By Date r] SPECIAL RMIT-Approved by_ <br /> Character of Soil to De h of3 Ft: PTU mp Soil Character: <br /> CO; NTS LO Le OF E' c L ^�) <br /> i <br /> PE~ Sc ReceivedChec Amount Permit/ <br /> Code INFO By CashDataInvoice# Permit IDH <br /> Remitted Service R uest# <br /> �f2r t!S 21o5(e �ac: Iv i <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 05l3rv2007 <br />