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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 CALL 209 9537-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4'�5 ' C/� �` CITY/ZIP ✓yLrt Nrv-Ec A <br /> CROSS STREET '1 I �' i�A•''-"�+' r,�+ APN -o40 — 1 D PARCELSIZE f'q, •Nt• p <br /> J :., 0 <br /> OWNER NAME E NJPr VV1 I�J W PE Z PHONE <br /> � ^ <br /> OWNER ADDRESS 9,C> p�.��C�C/�2,�' p v "ISTATE/ZIP /� L�L7�lArCA `���✓� <br /> CONTRACTOR LI Jr 0 P V- &C:0f-Aj VI RV T();'�E T H I_ PHONE—3 ip /-1- <br /> CONTRACTOR ADDRESS A4 C)-1 h', ' v I ` `3 T • CIN/STATE/ZIP <br /> LICENSE C-42 '.0-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: I 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 I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE _ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 It FOUNDATION ft 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. <br /> UM R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED NIMTITLE C c NSV l T YR�T DATE <br /> E <br /> N1y <br /> 71 FE' T <br /> EPARTME ON �1 <br /> Application Accepted ate Area Employee ID# <br /> Final Inspection By Date �1DZ� SPECIAL PER IT-Approved by <br /> Character of Soil to?ff pth of 3 Ft: Pit//SumprSr Character: <br /> COMMENTS f PSL _ iZ irtC !n [y <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Bv Cash jRemitted Service Re ue # <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />