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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 /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS E <br /> XP <br /> IRES 1 YEARFROM <br /> VROM DATE ISSUED <br /> JOB ADDRESS J CR <br /> p��S CN. N fir` CITYILr4 <br /> P TF�T�`i Cj•1 36 - <br /> CROSS STREET G - A-L- MLJ-0V APN Z I z - PARCEL SIZE 0-5& A y <br /> OWNERNAME 7 /�ym�'1� -AL //�/r��"�/ _T�PHHONE <br /> ' �,p� �/� CITY/S A ZIP rIYM,1 /- cA 45-35 <br /> OWNER ADDRESS 4r C� Aco <br /> rKA� ✓`�� "1p/,J`{"��-s� <br /> CONTRACTOR L(V C O•\rte V-LOp����I,�VN (r-TJL PHONE 3&,ci-03-'S <br /> CONTRACTOR ADDRESS w 0'`�- S - CITY/STATE/ZJP <br /> LICENSE QC-42 EIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X 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 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE It <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 24 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE �0�5�--I A^� DATE <br /> 13 ?099 <br /> � <br /> � co <br /> I ASF 7A i <br /> �veb <br /> I I �MFNr <br /> I <br /> ����D �ARTME US L <br /> Application Accepted By Area Employee I <br /> Final Inspection By Date C SP IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received Chec Amount Permit/ <br /> Code I Fo B miffed Date Service Request <br /> # Invoice# Permit ID# <br /> v i , ztnB V 391 ➢ ) 0��� <br /> 42-07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />