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ONSITE WASTEWATT <br /> t ,� REATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 01. ,'A9)468-3420 <br /> NoN-REFUNDABLE PERMIT CALL <br /> i(209)953-7697 FOR INSPECTIONS 7 EXPIRES 1 YEAR FROM DATE ISSUED <br /> J08 ADDRESS C f— CITylZIP 4Cj_ L CA <br /> CROSS STREET,_V f � APN �.�' /,.V"' }�_,.. PARCEL SIZE f� 8 UL'(' o <br /> OWNER NAME /lYl L4yk PHONE J r A <br /> OWNER ADDRESS ) r ff CITYISTATEIZIP SPP S <br /> I`- <br /> CONTRACTOR_ �y1f.IM1CP� Gd Gp�I►Ii�`dP-i"ti��`�l'�� PHONE � ``- DA <br /> CONTRACTOR ADDRESS _ ��'-A+t�y��"�. CITYISTATEIZIP ,"t k <Z:) <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> 1 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION* ?0 -Q <br /> TYPE OF WORK: Cl NEW INSTALLATION ❑ REPAIRIADOITION ❑ ENGINEER DESIGNED 7ALTERNATNE <br /> 1] REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Q RESIDENCE <br /> COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> LI SEPTIC TANK TYPEIMFG CAPACITY <br /> ydI #OF COMPARTMENTS n <br /> O GREASE TRAP TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE It <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES El LEACHING CHAMBERS #OFLINEs LENGTHOFLINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1] FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION f1 PROPERTY LINE ft <br /> 0 MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TQ NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> 0 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 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 /> M1NI UM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> !•PLEASE CALL(209)953-7697 /� <br /> SIGNED_ TITLE_ f �Ot t<f YY�7£sti DATE Ila-111>'k <br /> l <br /> TA <br /> r <br /> i <br /> 0 <br /> O <br /> f-f f N yq^.rJt iJ <br /> DEPARTMENT USf.ONL J <br /> Application Accepted Sy" Date Q Area Employee ID# <br /> Final Inspection By_ Date '3K O ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/Sump Soil Character: <br /> I COMMENTS Cv 11 � � / �-1 , + <br /> I <br /> PE SC Received eckfN Amount Permit! <br /> Code INFb B as Remitted Date Service Request# Invoice# Permit 10* <br /> �2 l.Paagbo5 a?t'a S Seo 7 f <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />