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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL.HEALTH DEPAn TM[N1 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT n CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS SOA1113 CtTY/ZIP S-rOCI1-7J <br /> CROSS STREET �t�/�( CNt, _ APN. O T^20 �2 7 _ — PARCEL SIZE <br /> OWNER NAME_ ����"� C f E�Y�N1�.I ----- —_PHONE -Z-7)- Z9ZYj_ _ is <br /> J <br /> 'l. <br /> OWNERADDRESS SA(^(r. sIc!ko'VL- CITY/STATE/ZIP <br /> CONTRACTOR , �C� C NJ"1ZpHONE----�GA J, ��-710N ----- <br /> CITY/STATE/ZIP CA S -CONTRACTOR ADDRESS 0 '1 U <br /> LICENSE .,C-36 OTHER / `_ NUMBER _�51�5] ... EXPIRATION DATE______ 201 or" <br /> WATER TABLE DEPTH: __ fl GEOGRAPHICAL INFORMATION: Coordinates X __. _,_ Y _ <br /> PERC TEST M i BUILDING PERMIT# ___ LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADOITION ENGINEER DESIGNED/ALTERNATIVE C <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER J <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: v <br /> ❑ SEPTIC TANK TYPE/MFG __ CAPACITY _ gal #OF COMPARTMENTS-- <br /> D GREASETRAP TYPE/MFG CAPACITY _ gal #OFCOMPARTMENTS_______ <br /> DISTANCE TO NEAREST: WELL _ _ 11 FOUNDATION it PROPERTY LINT __.it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP__ LJ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) L� <br /> - , f <br /> ❑ LEACH LINES J LEACHING CHAMBERS �Nt,1 ,{ _ #OF LINES Z LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL__'Ivo_-- It FOUNDATION it PROPERTY LINE `thQ <br /> ❑ FILTER BED WIDTH ft LENGTH -__ It DEPTH ft <br /> DISTANCE TO NEAREST WELL______ It FOUNDATION _ it PROPERTY LINE <br /> ❑ MOUNDED WIDTH _ __ It LENGTH __— it DEPTH_______.______ _ ft <br /> DISTANCE TO NEAR[ST WELL__ It FOUNDATION _ ._ It PROPERTY LINE <br /> ❑ SUMPS WIDTH _- 1t LENGTH _ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ It FOUNDATION _ it PROPERTY LINE It i <br /> ❑ DISPOSAL PONDS WIDTH -_ It LFNGTH __ft DEPTH_. it <br /> DISTANCE TO NEAREST WELL_ It FOUNDATION _ _ __ 11 PROPERTY LINE _ ft <br /> SEEPAGE PITS NUMBER _ WIDTH__..70-- _. __________ ft DEPTH <br /> DISTANCE TO NEAREST WELL-1 so it FOUNDATION ___SO It PROPERTY LINE 1Jp_ it <br /> I ,EREBY 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> TITLE - � �OtM DATE <br /> 1 <br /> I , <br /> i <br /> — V PAJv?TME,% T USE ONLYR 2� <br /> Application Accept y — --- Date { _ Area � ' __� Flsgaa���� <br /> Final Inspection By _-� _.._ _ Date ` SPECIAL PERMIT-ApprOvgtl�? C <br /> Character of Soil to D pth ofFt:, / Pit/t.ump Soil CharacterT/ilL <br /> COMMENTS -}1- _ S�r�`x ` ct�►►J f Z a-L-�J G-Gy"A la4A E� <br /> PE SC Received C.Phec�k_N_/_ AmounPerPermit/Code INFO B Cash Remitted Oat Service Re uest M Invoice# Permit IDM <br /> I S OP l Z <br /> 42,01 ONSITE WASTEWAT'EH TRTMNT SYSTEM PERMIT <br /> 4124112 <br />