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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 L • 1`�yCALL 209 953-7697 FOR INSPECTIOi+S EXPIRES 1pYEAAR FROM DATE ISSUED <br /> ' <br /> JOB ADDRESS ZTT�O N• -JAf+A&rT C-r• CITY/ZIP /7CtYKf <br /> y <br /> CROSS STREET )A-rtPtNT APN vvV-3`� PARCEL SIZE � Ar ' <br /> �J �j/J 1 // / ) 0 <br /> OWNER NAME COD7 IJ�1[�/G� .�(..`�` (I�-��LC/` IGtQ C-((7 '/t PHONE <br /> OWNERADDRESS1 P'o' 13Dx p/ZCO^ �IY71 Al A��W�P r7 /(161TV/JTA�TEIZI� LCJ/r\�T0 �5�3� <br /> CONTRACTOR y(4�• (��r�1f'� l7WENV�1LD/V N�`'v 1(�L PHONEd3�rA p <br /> CONTRACTOR ADDRESS `�7 W- OAKL ST- CITY/STATE/ZIP C' 1-7Z4Q <br /> LICENSE C-42 C-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 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 /> ❑ 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 WELL ft FOUNDATION ft PROPERTY LINE_ It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 It 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 It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R 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. I <br /> MIINNIIMW4':(�iOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED .(/"/KiC TITLE L , ^�^"" DATE GN� <br /> E,vED <br /> � 19 2pi� <br /> I <br /> o1R�U'MENU` 1 <br /> ON RTMEN <br /> X10 0EPP <br /> I <br /> DEPARTMEN O L <br /> Application AcceptMhf <br /> Date Area Employee ID# <br /> i <br /> Final Inspection By Date-� SPE IAL PERMIT-Approved by . <br /> Character of Soil to PiiUSumpp/Sooiill Character: <br /> OMMENTS <br /> m ;x sr= <br /> PE SC Received Check#/ Amount ate PermiU Invoice# Permit ID# <br /> Code INFO B Cash Remitted I Service Request# <br /> 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />