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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NONREFUNDABLE PERMIT ,C/A1 LLCL.x209 953-76977 FOR INSPECTIONS �ry�p�E,XPIRESGI YEAR FROM DATE ISSUED <br /> JOB ADDRESS O �-I W 1126 la u 1 6C I/I S T /+yz • CITY/ZJP!�"iT`��I l 3 0 <br /> CROSS STREETIM R'Cpn?- t-v(Z- APN Z�� 0 -Z�"� PARCELSIZE D'E <br /> fl-F-• b <br /> OWNER NAME m I G I"l r,�1... ' `2 m CV— PI 1`HONE, I , <br /> OWNER ADDRESS rJ �0 `r I LJ�J Cr Y/STATE/ZIP n—fl y /�c'� Ill �30 T <br /> CONTRACTOR LIVE OA"- Ur-0kZ- lV)(Z0n1('�1 E,N)iqL- PHONE 3 629-037 ST- <br /> CONTRACTOR <br /> ADDRESS q01 tA)• 6 �� ST• CITY/STATE(ZIP L-0�'1 1 GQ <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft 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 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, _1 <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. c�,�•P <br /> _ MINIMUM 24 OOJA ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 c, J <br /> SIGNED r!/ v`'_ 1 /` TITLE (-C?VSyL 1 1`1 NT DATE <br /> RQVC^,C <br /> �pMEti��Y <br /> ARTMFNT <br /> I <br /> I <br /> I i <br /> I <br /> I I <br /> I <br /> I <br /> I I <br /> �bEPARTME ON <br /> Application Accepted By ///(/l _ /,! _Date AreaEmployee ID#�� �� �/�Y�1`� <br /> Final Inspection By Date ❑ $PECILIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Ch Amount Permit/ <br /> Code INFO BCash emitted �Date Service Re uest# Invoice# Permit ID# <br /> / <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />