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= it:tet ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> N6N-REFJNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS r _ CITY01, 16 if, <br /> CROSS STREET r _ APN / O i' V PARCEL SIZE <br /> ,/ PHONE 2 O! `33 7�91 <br /> OWNER NAME /OP'1 1� f <br /> OWNER ADDRESS A67FA4 CITY/STATE/ZIP <br /> CONTRACTOR GO 41 ,J///�IlG�nt&444 PHONE <br /> ?5! <br /> Z�L� ��,� /��/SQ((/••-''+''fir <br /> CONTRACTOR ADDRESS L J! Y 16,4 6n A CITY/STATE/ZIP <br /> LICENSE 1.1. C42 II C-36 OTHER 04 NUMBER 7 !c'z.jiI6 EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH: f6 71 ___ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# - b _ _LAND USE APPLICATION# <br /> TYPE OF WORK: A NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTK)N <br /> INSTALLATION WILL SERVE: I1 RESIDENCE Y,,COMMERCIAL h( OTHER -Q <br /> NUMDER OF LIVING UNITS: fNUMBER OF BEDROOMS: 7� NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG IJOIGI�7 F/ CAPACITY w JB1 #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG �7 CAPACITY— � - gal #OF COMPARTMENTS <br /> — <br /> DISTANCE TO NEAREST: WELL C+�� - ff FOUNDATION ,L ft PROPERTY LINE 7-00 It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> T LEACH LINES LEACHING CHAMBERS #OF LINES �LENGTH OF LINES h <br /> DISTANCE TO NEAREST WELL It FOUNDATK)N ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH h <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> y DISTANCE TO NEAREST WELL ft FOUNDATION I TP R PROPERTY ft <br /> 1 <br /> q SUMPS WIDTH 1 / It LENGTH ZA ft DEPTH it <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH_ ft DEPTH it <br /> DISTANCE TO NEEE[A[�SESTWELL ft FOUNDATION _ft PROPERTY LINE it <br /> SEEPAGE PITS NUMBER WIDTH 14: ft DEPTH_ fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER LINE h <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED __.. _ TITLE A rG L a� DATE <br /> 01 <br /> 2 <br /> I 1 <br /> P� <br /> 40 r I <br /> n Ul L <br /> Hfill I I,,I <br /> DEPARTME <br /> Application A. <br /> v i Date 2 Area 4 'L Employee ID# E S C OTIC <br /> Finallnspectionrepth <br /> - - Date FJ SPECIAL PERMIT-Approved by <br /> Character of Soil toof 3 Ft: PI ump Soil Character: <br /> COMMENTS �-L'T OF /Lr--Co.2D 64,04)c •�£�rH ?V �%u Nyuln r�,Q (pb �E£! <br /> PE SC Received two Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/2402 <br />