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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOJIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7_697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I-A _CITYIZIP 5o� GKja* la <br /> CROSS STREET /ZBNfA7C- 122 APN _PARCEL SIZE <br /> OKNERNAME PHONE :�15- ;i/2G'47 1C37 <br /> ! <br /> OYWERADDRESS //7lS J'. &P?1A,,1 D/ CITYISTATE21P <br /> CCNTRACTOR CA665-(t/Ey `p tjj�C(LT11NGT PHONE GlI TJ l�3 <br /> CONTRACTOR ADDRESS nn dd .y`3 747-4 CITYISTATE!ZIP._►.-j�cJZL D� Zjr38/ <br /> LICENSE ,.C-42 C36 OTHER�j�/,}}•79 NUMBER EXPIRATION DATE G��d/J 7-- <br /> VPWA RTABLE DEPTH: ��+ fl GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ERC TEST BUILDING PERMIT# LAND USE APPLICATION# ( _ Z <br /> TYPE OF WORK: _ = NEW INSTALLAnON REPAIR/ADDInoN 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 /> D SEPTICTANK T1•PE.DA=G CAPACITY <br /> 931 t1OFCOh1PARTMENiS__ <br /> ❑ GREASE TRAP TYPE%M=c __ _ CAPACITY_ gal X OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL (t FOUNDATION It PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES -Cl LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl <br /> DISTANCE TO NEAREST WELL—,,---- It FOUNDATION _It PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH It LENGTH R DEPTH f1 <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> O MOUNDED WIDIH _It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL-____ It FOUNDAnON _ ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH_-_ It LENGTH (I DEPTH It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH __h LENGTH h DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LINE _It <br /> ❑ SEEPAGE PITS NUMBER _ WIDTH_ __fl DEPTH fl <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTVLINE 11 <br /> I HEREBY CERTIF AT I HAVE PREP D THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> /l MINI UWADVANCE NOTICE REQUIRED FOR INSPECTIONS-CPLLEASE CALL(209)953-7697 <br /> SIGNED TITLE QWNF-.P� DATE <br /> I <br /> Ly <br /> I T <br /> D <br /> I <br /> I4 AL 2012 <br /> Ti <br /> I <br /> I ! — <br /> I <br /> _ I <br /> I <br /> i <br /> DEPARTMENTUS ,NLYI <br /> Application Accept r Date Z� LArea Employee ID#- <br /> Final Inspection By Date_ % b3 <br /> L, SPECIAL PERMIT-Approved by <br /> Character of Soil to De hof 3 Ft: PittSump Soil Character: <br /> COMMENTS " �\ I D Old 2 7 7 <br /> Cyr ! z--e- Z�_•` Ire __ f <br /> PE SC Received Ch-k#/ Amount Permlt/ - - ---- <br /> Code INFO B I Cash Remitted Qate Service Request k Invoice# Permit ID# <br /> 2 <br /> 37-0 ONSITE WASTFNATF_R TRTMNT SYSTEM PERMIT <br /> 1 Q'tQ' <br />