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le �i <br /> 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 /> Joe ADDRESS C //C__ITY0P <br /> CROSS STREET /..fi0 APIN �`� �1lJ�i�d 1 PARCEL SIZE •S g <br /> tl <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITYISTATEIZIP rn <br /> CONTRACTOR ./ /,.,Ir PHONE <br /> CONTRACTOR ADDRESS,Z12f-Z__Z L; !-h CITYISTATEZIP <br /> LICENSE ,;;rC.42 L JC-36 OTHER NUMBEII_7 EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# —� <br /> TYPE OF WORK: 0 NEW INSTALLATION REPAIRIADDITION O ENGINEER DESIGNED!ALTERNATIVE <br /> 0 REPLACEMENT 1-. DESTRUCTION <br /> J INSTALLATION WILL SERVE: :1 RESIDENCE 0 COMMERCIAL I1 OTHER <br /> ( NUMBER OF LIVING UNITS' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG __�At S CAPACITY gal #OF COMPARTMENTS A <br /> ❑ GREASE TRAP TYPE/MFG ti— CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLy <br /> r� ft FOUNDATION ft PROPERTY LINE ft <br /> ,�❑ LIFT STATION S12E TYPE OF PUMP ❑ PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> '7p4,[ LEACH LINES - LEACHING CHAMBERS #OF LINES LENGTH OF kJNES <br /> ' ) DISTANCE To NEAREST WELL /!//J���ft FOUNDATION ft PROPERTYLINE <br /> ❑ FILTER BED WIDTH ft LEN—NG77THft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft S <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f! ? <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DIsTAHCE To NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ D%SPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft - <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> SEEPAGE PITS NUMBER 2 WIDTH J ft DEPTH_71 S- > f <br /> DISTANCE TO NEAREST WELL dI ft FOUNDATION JD ft PROPERTY LINE�j 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 /> MINIMU 24140 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 +�/ <br /> SIGNED TITLE 7-// DATE 3d 1� <br /> i <br /> fl- <br /> jy <br /> t <br /> � I <br /> r r <br /> I <br /> I <br /> � � s <br /> � 'jv�)1/'I{yl1y/ <br /> c ra <br /> DEPARTMENT US ONL <br /> Appli=tlon Accepteda - <br /> f <br /> Date d Area Employee 1D <br /> Final Inspection BDate / E, SPECIAL PERMIT-Approved t <br /> Character of Soil toPitl ump Soil Character: <br /> COMMENTS <br /> PE SC Received he" Amount PermiU Invoice# Permit 10# <br /> Coda INFO B s Remitted Date Servlu ueat# <br /> 0 21 "� 3d a g-co S s-S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014/07 <br />