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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 /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS d� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 39o r /�E- Em�B" AZ)- CITYZP 7TH- WL PD �` <br /> CROSS STREET q I Imo• A(-IE' APN 00r-14J _ ' I PARCELS¢E LIZ �• F <br /> 0 <br /> OWNER NAME ,I,� �7�NN mI.�Z .rte- A�PHHO,�NEE� <br /> OWNER ADDRESS �J /�'�vj�, Q��D / ,� T�p CrrYJSTATE21P I Cf"T- 'PO <br /> CONTRACTOR L-I V C L��V- E�y)F-�� (i'�+ , r`L- PHONE 3&"-p3 +3 <br /> CONTRACTOR ADDRESS ` ol- W 0A)e—, 57-. CITYISTATEIZIP LOar Gft Cff-2- L0 <br /> LICENSE :JC-42 'C.36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> _ERC TEST # l BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: a NEW INSTALLATION REPAIPJADDIIION G ENGINEER DESIGNED]ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: L RESIDENCE J COMMERCIAL J' OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES C LEACHING CHAMBERS *OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 /> MIMUMI UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / <br /> SIGNED TITLE Go�svLTH,.rT DATE `'f -21-t y <br /> I � <br /> 9 209 <br /> Pb5 ENT 7yMZA <br /> I <br /> I I � <br /> DEPARTMENT�LYSE ON Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PWSump Soil Character. <br /> COMMENTS <br /> PE SC Received Check#/ Amount PertnlU Invoice# Permit ID# <br /> Code INFO p emitted Date Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />