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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(2091 468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953--77►6(9�7 FOR INSPECTfONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS� �� v/ L� •�" _CITY/ZIIP ►'!'�1 <br /> CROSS STREET l�! O'}�� APN `'.�5) ��! - PARCEL SIZE b <br /> O <br /> OWNER NAME L—"(1"7 .' PHONE <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR_/1�7 1 IG�� �rC/ f�� ` PHONE C <br /> CONTRACTOR ADDRESS L1 L �tin� n_CITYISTATEIZIP- 1�Y� YT fT� "T G• f 7� <br /> LICENSE [.1C-42 IC-36 OTHER NUMBER 1/7>5y J+PIRATION DATE T 61 _. <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X_- ._ Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I_. NEW INSTALLATION REPAIR1ADDiTION f1 ENGINEER DESIGNED IALTEP.NATIVE <br /> REPLACEMENT i OUT-0F-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> �INSTALLATION WILL SERVE: (�jRESIDENCE J COMMERCIAL OTHER -- � <br /> UWIBER OF LNING UNITS: I NSJMBER OF BEDROOMS: - ___._NUTABER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEJMFG CAPAC'-Y gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPUMFG CAPACITY gal #OF COMPARTIJENTS <br /> DISTANCE TO NEAREST: WALL It FOI NDRTION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT LJ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> EACH LINES I LEACHING CHAMBERS #of LIN-_s LENGTH OF L.I:FS—�L �r It <br /> DISTANCE TO NEAREST WELL -- _ft FOUNDATION_ ft PROPERTY LIVE <br /> ❑ FILTER BED WIDTH It LENGTH fl DLPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPFRT:'I.NF <br /> L7 MOUNDED WIDTH ft LENGTH R DEPTH ft 11 <br /> DISTANCE TO NEnAREST%/ WCLL ft LOUN^A.TIDN i ft PR: UNE - ft <br /> �UMPS WIDTH � ft LFNGTIIis <br /> _ t h DEPTH_ ll ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATIDN It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft (n <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft C <br /> U SEEPAGE PITS NUMBER WIDTH !ft DEPTH -II ^\\ <br /> n <br /> DISTANCE TO NEAREST 'NhLL R POJNDATION ft PROPERTY LINE fL II <br /> I <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK VNLL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 jt�QUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE L fJ3 -1-,�� DATE y I <br /> � t i <br /> - <br /> - <br /> I <br /> r <br /> ►•i � I <br /> I <br /> DEPARTMENT' USE ONLY -' <br /> Application Accepted By Date -2 Area Employed ID# <br />