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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> rION-REFUNDABLE PERMIT CALL{209}953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ' 4 .~ ,. C .f ' w �� CRYIZIPI`�"�' �--� ; q VJ <br /> � 1 c-. 11 '17 1-0 - <br /> CROSS STREET :: ' C� s'---^' .. �h APN !1( �) .!`�T' PARCEL SIZE Z p <br /> 0 <br /> OWNER NAME EC .I�:"S 4•, k?- "S�f PHONE '( <br /> fn <br /> OWNERADDRESS i, S i. .A CITYISTATEIZIP N_r e- C_F'- 11K <br /> CONTRACTOR �A._' 1....� PRONE [ -l4 <br /> CONTRACTOR ADDRESS �' vim.•� �+^-•` � fCITYISTATE21P <br /> LICENSE ❑C-42 11C-36 OTHER NUMBER ExPIRATION DATE \ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Ik PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> U REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL Cl OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 0 SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> I3 GREASETRAP TYPE/MFG CAPACITY gal 9 OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE tt <br /> LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) j <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft , <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> O FILTERt3ED WIDTH ft LENGTH It DEPTH ft Y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> E3 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION k PROPERTYLINE ft <br /> 0 SUMPS WIDTH ItLENGTH ft DEPTH It <br /> i <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLiNE ft <br /> 9 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> i <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ;IY FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICA-h ON AND THE WORK WILL IBE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED .c_ _ - �._....j-, .., .� 4_.w TITLE !.F !�•-�- DATE I Z, _I <br /> In <br /> Ell <br /> I <br /> r ' <br /> / I r 11 iV <br /> I "M <br /> i <br /> DEPARTMENT USE OlI <br /> Application Accepted By w„ !(•<�i:.r\ __id, � r �f ;6'.- Area Employee ID# <br /> !.,. Date �> .r? d.3; <br /> 1 <br /> Final Inspection By � Date q SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiVSump Soil Character: <br /> COMMENTS <br /> PE SC Received CheclI Amount Permit/ <br /> Code INFOB Cash Remitted Date Service Request# Invoice# Permit ID# <br /> -LTA _.14(: I:J::: ;;! -.r4I� ? <br /> t <br /> I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 101"7 <br /> 1 <br />