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pap 1)- <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQVIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON'CA 95202 -(209)468-341.0 <br /> NON-REFUNDABL PERMIT CALL(2091953-7697 FOR INSPECTIONS PIRES I YEAR F OM DAT ISSUED <br /> JON ADDRESS ^/ _ ./L-1 lJ �l/��( `CITY/ZIP /1 <br /> CROSS STRYET ^ ���'��l��V r� ^`1\ ',t /Y APN Cot n I ZI 0�CI '7PARCEL SUIT£//��D+�/p�{b/`gy-1 ._ o <br /> OWNER NAME L I+�(y1�'�] f•�1.-��..� 1-�i N" PHON L/ly�-/� <br /> OWNERADDRESS �'N'i ('1 ` CITY/STATE/ZAP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATL7A P <br /> LICENSE ❑C-42 ❑C•36 OTHER NUMBER EXPIRATION DATE_ <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: C06fdinatell X Y <br /> ❑ PERC TEST #_� BUILDING PERMIT# LAND USE APPLICATION e <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDEsIGNED/ALTE3tNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:_ ,.n NU MBER OF B EDROOMS: NUMBEROFEmnoYELS: �7 <br /> SEPTICTANK TYPEIMFG 'Y�-L-- CAPACITY ��'V gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE'MFG_ CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: W ELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION Stu TYPE OF PUMP D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> l�C <br /> ask LEACH LINES ❑ LEACHING CHAMBZRS 2 #of LrNES q LEr:cm OF LINES j�l ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION— ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LEN'GTHt:✓7{�T2- ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION R PROPERTY LINE R "i <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNZAT�ON ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ R DEPTH It <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft , <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 2Y'RO""DV,ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ^ TITLE QI'`�• t'YL._ DATE <br /> L � <br /> i <br /> i <br /> i <br /> II I <br /> •� T <br /> IF C <br /> 0 <br /> SA I <br /> d A UI <br /> I <br /> �I <br /> DEPARTMENT US7 ONLY �J <br /> Application Accepted B Date x U Ar® vv) Employee ID# dl gg <br /> Final]as .1-a B Date ❑ SPECIAL PERMIT-Approved by <br /> Character Of Sail to Depth f 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS � ���� lY�f �� I� nf/sJrz afa �haP� <br /> J <br /> PE SC Received Chec Amount Date PermlU invoice# PeradtlD# <br /> Code INFO B Caxh Rcvdtted Service next# <br /> FZ.r 1 IIT ,'L 3 u. is L: 0 / <br /> 42-02-001 <br /> ONSITE WASTEWATER PERMIT <br /> 122221101 <br />