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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 ►7 r�^ CALL 2.0J)9-/53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM cDATE ISSUED <br /> JOB ADDRESS 15- } 15- J 5. tN V+v` �`-� ��• CITY/MP J ✓�'I�T� R Z-I> -vy'I <br /> CROSS STREET /�O• '���D�/ APN (85-- rTE) -3o PARCELSIZZE Z•2S A-C b <br /> OWNER NAME A L-t—C PJ C-Ak ohi p PHONE 0 02-')3.74- 1 7-�Z <br /> OWNER ADDRESS -753-0 �. A-M I•'r(��-y CITY/STATE/LP 5��'r--ri5rj C S— <br /> CONTRACTOR l-I JE OS�T P// Y— GCO ENV 1 Ko PJM CAJT A C— PHONE 3��-�3-7 S � <br /> CONTRACTOR ADDRESS o-7 L�I - OAK- 5 I . CITY/STATEIZ1P I C A q`r7r4T <br /> LICENSE G,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 ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP 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 ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> MINIMUM 2 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE coNr;vLTRNr DATE <br /> 'J <br /> I RAN�N CSU <br /> D�pARNM NT <br /> I <br /> DEPARTME'/NST tSE LY / <br /> Application Accepted By Date 7' 1 lf� Area `Y f loyee ID* S j -_- <br /> r � <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiVSump Soil Character. <br /> COMMENTS <br /> PE SC Received /Chec Amount Permit/Code INFO B Remitted ?ate Service Request# Invoice# Permit IG# <br /> I <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />