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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1"IQ40 1 s• D A+4 W n1 AVE. -CITY/Zip ESGft ILZ9 S"3 Zp <br /> CROSS STREET 1 U<.L.�2Ey APN ?�(--�-—130-3q 'i--3!- pARCEL S¢E I c <br /> OWNER NAME J O c B PCJ A g-0 PHONE EG!�' T a <br /> OWNER ADDRESS p�,�,dX L�7 ��7 CIN/$TATE/ZIP r�Gf�LO V1 T [s�Zd <br /> CONTRACTOR 1-44 LL,O���+�-F�- �0EAJVJ�0AJMt�7eVL- PHONE .3�9- 03-4� <br /> CONTRACTOR ADDRESS +D T " - 0 Ay- S-F. CITY/STATE/ZIP L-U D 1 CA 9; <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # ZF BUILDING PERMIT# LAND USE APPLICATION# A-18 001—r T47 <br /> TYPE OF WORK: 0 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 WELLft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ��` �q <br /> El MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ����p <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE B <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft ,f°� J <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE eLIIj- 20799(� <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ri �•C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE T D°PMF�TAL Ty <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, `�RTMEN7. <br /> N]%�y STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �IMUM`—HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ,/`� TITLE �A)SVt-+/Y�v I DATE 7- <br /> {nypgy <br /> 9 <br /> --._-----_.mss_______________________� I <br /> �\ n <br /> Oi L `lam— —- -�—�J —Y <br /> DEPARTMENT U E ON Y q/y� //��� <br /> Application Accepted By Date Z 1 d Areal//l J Employee ID# "�V� <br /> Final Inspection By IV V Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received Chec Amount Date Perm Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> a2-0'I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />