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ONSITE WASTEWATER- 'EATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202. x166-3420 <br /> NON-REFUNDABLE <br /> ��jjPERMIT 1 e, CALL 209 953-7697 FOR INSPECTIONS/1 EXPIRES 1l�YEAR <br /> \FROM DATE ISSUED <br /> JOB ADDRESS �Ro / yvUC'c r-, qC �4pj CITY/ZIP /iCAr^pc) \-� �IS�-J-U `CA <br /> [ M <br /> /f�` <br /> CROSS STREET /'S� B` N W! C APN V I 11 Q ;-qCP�ARCEL S`IZ[E�.�"/Cr/ �{ a <br /> OWNER NAME 'AL I!A f- L)S SE I 1 1 @' .S PHONE <br /> OWNER ADDRESS 17 q1.- <br /> �rrr I6j2r / CITY/$TATEX/}ZIPA7 p�1 �TC��7Y�� <br /> CONTRACTOR ej /1v5; PHONE <br /> CONTRACTOR ADDRESSD C <br /> fi' G1J <br /> J /J <br /> 2 /I c,f 1) Ct CITY/STATE21P V h I PVI CA q S-(,J <br /> LICENSE 1.1C•42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: GEOGRAPHICAL INFORMATION: COOrdlnate5 X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# 0 0 <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT L 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES IJ LEACHING CHAMBERS — #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 It DEPTH It <br /> DISTANCE TO NEAREST -WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> I HEREBY CERTIFY TH T 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE <br /> DATE <br /> JO <br /> VI O M <br /> FA,E <br /> s TA Cr <br /> C) <br /> EPARTMENT U E O L <br /> Application Accepted B Date Area Employee ID#40p" <br /> Final Inspection By Date 11SPECIAL PERMIT-Approved by j <br /> Character of Soil to De th of 3 Ft: Pit/Sump Soil Chara <br /> COMMENTS �� <br /> .c . <br /> PE SC Received Amount Date Permit/ <br /> Code INFO Cash emitted Service Request# Invoice# Permit ID# <br /> ? IO -- b5-66 <br /> �?,��� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />