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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR <br /> �FROM <br /> )DATE ISSUED <br /> JOB ADDRESS O N CITYIZIP_ CAM 100 �•' —_ <br /> �` <br /> •� <br /> PARCEL SIZE z <br /> CROSS STREET "O APN PHONE O0C_3Q_7790 <br /> OWNERNAME <br /> v, <br /> p/' l <br /> OWNERADDRESS `�` CITYi$TATL/ZfPq�'�AmPO Ll1A IJ�oa_� <br /> CONTRACTOR q <br /> �1` S yr r r1 (6—5v l l f-e-. PHONe 1-o I r 7 W '-.3 g_i <br /> CONTRACTOR ADDRESS CS 31 m <br /> C n/Q r CITY/STATEIZIP VA]1 e )' -S f SSS <br /> LICENSE .JC-42 CIC-36 OTHER NUMBER EXPIRATION DATE <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> WATER TABLE DEPTH: •� _ <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> ] REPAIRIADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> TYPE OF WORK: :J NEW INSTALLATK)N 71 DESTRUCTION REPLACEMENT f <br /> INSTALLATION WILL SERVE: Li RESIDENCE 2 COMMERCIAL LJ OTHER it <br /> NUMBER OF LMNO UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I] SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 13 GREASE TRAP TYPE/MFG CAPACRY gal #OF COMPARTMENTS p <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION <br /> ft PROPERTY LINE ft V <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT L3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS #of LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ft LENGTH ft DEPTH ft <br /> O FILTER BED WIDTH ft PROPERTY UNE ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft LENGTH ft DEPTH ft <br /> O MOUNDED WIDTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O SUMPS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL <br /> R FOUNDATION ft PROPERTY LINE ft <br /> ft <br /> O DISPOSAL PONDS WIDTH ft LENGTH DEPTH ft <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> WIDTH ft DEPTH ft <br /> O SEEPAGE PIT'S NUMBER ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> I <br /> I HEREBY CERTIFY THAT 1 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 /> MIN{MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED /vim! TITLE L'��la.�e( DATE <br /> 1 <br /> I <br /> MEAT <br /> -E <br /> ` 9 <br /> A J -210 <br /> UNTY <br /> Fi AL <br /> ENT <br /> 1 <br /> FTT <br /> o <br /> –•DEPARTMENT U OILY r._..�/J .y� • <br /> iApplication Accepted By Date 3 Area Employes ID# <br /> Final Inspection By Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3 Ft: PIt/Sump Soil Character: <br /> COMMENTS L7Oa z d <br /> o <br /> PE SC Received he Amount Date Permitt Invoice# Permit IDN <br /> Cods INFO B as Remi Aefvlce Re vest# <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 1014107 l6—'67 <br />