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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 149 953-7697 FOR INSAECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS_a 0 <br /> ID <br /> CROSS STREET 1iPN /O � [14 VJ�2� _—_PPAaRRCEEL SIZE _ <br /> ` OWNER NAME 'T <br /> PHONE V 1 <br /> OWNER ADDRESS IF'�- - C1ITYISTATEIZIP LSA C44 ��Z <br /> q / <br /> CONTRACTOR D 4^ b r (* /G PHONE O <br /> CONTRACTOR ADDRESS i CITYISTATE0P <br /> LICENSE 4C-42 L}C-36 OTHER NuMaER� EXPIRAnON DATE <br /> WATER TABLE DEPTH: _R GEOGRAPHICAL INFORMATION' Coordinates X Y <br /> LPI PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADOITION ❑ ENGINEFR DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT fl OUT-OF-SERVICE SEPTIC SYSTEM D DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCEOMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: �j NUMBER OF EMPLOYEES: _0 C) <br /> 1 - <br /> E Cl SEPTIC TANK TYPFWFG t CAPACITY <br /> gal #OF COMPARTMENTS <br /> $ Q GREASE TRAP TYPE(MFG CAPACITY gal #OF GOMPARTMENTS <br /> l DISTANCE TO NEAREST: WELL �fJ 0 'F It FOUNDATION ik PROPERTY LINE ry <br /> 0 LIFTSTATION SIZE TYPE OF PUMP LT PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS ZQ f #OF LiNES <br /> �._ /� LENGTH OF LINES Tiv <br /> DISTANCE TO NEAREST WELL IQ 0 i- ft /FOUNDATION O $ PROPERTY LINE /4t> ft <br /> Q FILTER BED WIDTH ft LENGTH ft DEPTH �ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION H PROPERTY LINE ft <br /> I Q SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft (� <br /> Q DISPOSAL PONDS Wom ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE it <br /> SEEPAGE PITS NUMBER d WIDTH If —R DEPTH CS A ft <br /> DISTANCE TO NEAREST WELL RjQ P_f1 FOUNDATION �ZJ R PROPERTY LINE !� -3F- <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 /> MWIM M 24 fi0 li DVAPICE NOTICE REQUIRED FOR INSPECTIONS-PL ASE CALL 209 953-7697 <br /> SIflNt=D TIT V` DATE 16` <br /> -141-7 <br /> L <br /> 4 <br /> ri- <br /> rl <br /> ����` r—'.s•-,..�.:-r-- — - — O-EPA'R'T7MEN <br /> �� Application Acce bate Area Employee ID#�^ <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> Character Of SOII to epth of 3 Ft: _ Pit! ump Soil Character: <br /> COMMENTS <br /> PE SC Received Amount Date PermlU Invoice* Permit ID# <br /> Code INFO B -Cash Remitted I Service Request N <br /> 2,l <br /> 4-7 / IWO 6.23- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9121110 <br />