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VIY91 1 IG mmo i GYYN I CSC I KCA I MCN I JYJ I tM F'tKMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDA13LLE�E(PERMIT tt CALL 209 953-76)97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I O'i�� L• �� -EI�I /� (,-.!�) CITY21p •L0�I �, ��� y <br /> N <br /> CROSS STREET `ruLL�j APN 05;3- 050- �-c7 q ^^__ " <br /> p �i PARCEL S¢E I ! rn o <br /> OWNER NAME bvy I GH"f 5V'S//�lyn�I�1L(�GC r7 PHONE Q /- <br /> OWNER ADDRESS �ft90-4S w]n L-4Ajt, CIT`//STATE21P I_Loomis CA �Iy'IP� <br /> CONTRACTOR LI Y L O((P<V- EN�I 2P�N'�EAN'A L- PHONE 3 t r p 7� <br /> CONTRACTOR ADDRESS TD "I w' OA� '57 CITY/STATE/ZIP L-011>1 CA r S-Z14y <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT#. LAND USE APPLICATION# PA-1(000 1-00 <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 TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE To NEAREST WELLIt FOUNDATION R PROPERTY LINEA <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH -VA—, v`O <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE fj <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH �ft ZD1y <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE p�Q( v <br /> COUN <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH � <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE 'Y <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, EHT <br /> STATE LAWS AND RULES AND REGULATIONS�OF SAN JOAQUIN COUNTY. <br /> INIM`U OUR ADVANCE NO110E REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r G <br /> SIGNED_ / G!'� ` TITLE G 0 N,SVL DATE 3 <br /> .......... .:'•i <br /> . . <br /> 6 <br /> y <br /> �I <br /> r` <br /> ---------- <br /> coo . , <br /> I________________ -_ <br /> OVERALL SREL S <br /> PUN •.f u- _--_0.0 TARMR PLAN _--_ <br /> ®- VJ <br /> _ rD <br /> AR TME T ON <br /> Application Accepted By ate Area Employee ID# <br /> Final Inspection By Date El $PECI L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC ReceivedChec Amount PermiU <br /> Code INFO B ash miffed ate Service Request* <br /> Invoice# Permit ID# <br /> a <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />