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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT tt <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT <br /> �- CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS LL�i d• j/—Ug U ala cITY/ZIP <br /> APNPARCEL SIZE CROSTREET DyJ!//]5 p TS F <br /> OWNERNAME yPNONE m <br /> OWNER ADDRESS ITY/STATE ZIP <br /> CONTRACTORG""rJJ /dL ZAZ&—u Se /J//h'f :3r-2- <br /> fK o _ PHONE S�Z 7^. <br /> t � <br /> CONTRACTOR ADDRESS 7CCY� ��1�.tsL�/2cf z-,4"" CITY/STATE/ZIP li��'^ C <br /> LICENSE JAC-42 ❑C-36 OTHER s ;NUMBER EXPIRATION DATE O7-3/-/O <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> C PERC TEST # BUILDING PERMIT# 0 F101`YTD LAND USE APPLICATION# if <br /> TYPE OF WORK: NEW INSTALLATION Li REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ' <br /> ❑ REPLACEMENT ❑ DESTRUCTION ^� <br /> INSTALLATION WILL SERVE: 0 RESIDENCE tg COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: b NUMBER OF BEDROOMS: e15 NUMBER OF EMPLOYEES: ' <br /> (it- SEPTIC TANK TYPE/MFG CAPACITY_ ;�r(L! gal #OF COMPARTMENTS <br /> U GREASE TRAP TYPE/MFG CAPACITY 921 #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL I_W It FOUNDATION �, It PROPERTY LINE • J!(2• It <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 3, LEACH LINES V,LEACHING CHAMBERS ' #OF LINES '7 LENGTH OF LINES Xy/ ft (~�j <br /> DISTANCE TO NEAREST WELL /'%b' It FOUNDATION '56 It PROPERTY LINE <br /> 0 FILTERBED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY UNE ft <br /> SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft 1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft I <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft. <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE ft <br /> i <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <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 i <br /> SIGNED TITLE r,�pg '.6.r DATE 1 <br /> REUt. EDp <br /> wy <br /> IPmVRONMEWAL <br /> JFJT D P Ems' <br /> 1 <br /> S <br /> I <br /> Y <br /> i <br /> 4A_)iQ_" <br /> �,.,.,�-„r _ __;,moi-DEPARZMENTU EON Y_ <br /> Application AcceDate 0 V Area Emptoyee 10# <br /> Final Inspection Date / �`�l l SPECIAL PERMIT-Approved by <br /> Character of Soilof Ft: _ PIt/Sump Soll Character: <br /> COMMENTS 330/[ c_ <br /> PE SC Received Amount Date ParmlU # Permit <br /> Cade INFO Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />