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vrval I t VNAJ I LVVA I tK I KEATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202•(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209953-7697 FOR INSPECTIONS FxPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS LO 3 Lo�•. C♦N tn�L�" LI ISI o C--r- G�'1 CITYZJ <br /> P S-7 C r73'r1 R A <br /> CROSS STREET LttGO(ZI APN 00 1- I O 43 PARCEL$P.f . S Ac <br /> o <br /> OWNERNAME A'D�IArnJ @JIrV"Tt-(Ly <br /> PHONE <br /> OWNER ADDRESS SK t CIT'/STATEIZIP <br /> CONTRACTOR L L VC`1p�f1 K- CrE0t;? 1y 120fQ mYL <br /> E7-rr PHONE :1(9.9 -03-75- <br /> CONTRACTOR ADDRESS Or`�"' ST' CITY/STATE/ZIP I GA q'5' <br /> LICENSE QC-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ 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 It 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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft e <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <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 ?8 <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE SAAQ✓ 20 <br /> ElDISPOSAL PONDS WIDTH ft LENGTH R DEPTH qQU� �9 <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY LINE 8-4/ 0 N C I✓N <br /> Z1 SEEPAGE PITS NUMBER WIDTH ft DEPTH It 4pgRNo '!- <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft TM�NT <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 /> INIMUM/y2 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 G a <br /> SIGNED � l TITLE CONSVLI DATE <br /> i <br /> 7" <br /> EPARTMEN E <br /> Application Accepted By Date Area Employee ID# lAUE-- <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received rChqAmount Date Permit/ Invoice# Permit ID# <br /> .Code INFO B ash Remitted Service Re uest# <br /> 2 � <br /> 42 01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />