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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 140 STvNEtz,)D*sE DZ CITY/ZIP t 2r'�-Cy D y <br /> �7 `T' -a <br /> CROSS STREET ��`^"v T �-'i IV r `APN L 7 / 5— I PARCEL SIZE 4�- m <br /> OWNERNAME -l�I—`LA / 7� T PHONEZ <br /> _�..J�1'ZC3J� - ��s/s-`}' I(P <br /> OWNER ADDRESS -` J W ���N E� 1�J�. CITY/STATEMPP1V-�I] <br /> CONTRACTOR LI V E DP't� Gt DqEN�/1��m t N I�CL PHONE �{&q T <br /> / <br /> 7—0 3 S q <br /> CONTRACTOR ADDRESS 4k � III%)- O CITY/STATEIZIP i-O D, <br /> LICENSE ❑C-42 ❑C36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Ix PERC TEST # I' BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> El REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: G RESIDENCE ❑ COMMERCIAL ❑ 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES K <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH `, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH A!ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft O•V <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE-----_E���i �] <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH n A'OU/�/T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE '•�Q/ '7 <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ftC'/S/� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 /> INIMUM 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9S3-7697 12 <br /> SIGNED TITLE CONS✓L--171"I J`J I DATE ! ^l <br /> I\ <br /> i <br /> ^" 1 <br /> I � <br /> EPARTME T S 0 LY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date 0 SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiUSump Soil Character. <br /> COMMENTS <br /> PE SC Received Che Amount Perm <br /> Code INFO B as / Remitted Date Service Reiuest# Invoice# Permit ID# <br /> 315 11 Sk 00 <br /> i <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />