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UN,I I L WAS I EWA I EK I rKEATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4653420 <br /> NON-REFUNDABLE PERMIT CALL(209) <br /> (209 9573-77697 FOR INSPECTIONS /�,EXPIRES'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS_ I b.� ZD VoW S DSS •C-� IAV CITY(ZIP -C�1 L.y q 5 3 y,' <br /> y <br /> FA pcJ�J S E N - '572-q <br /> CROSS STREET �7 APN Z t7 1 � ��V , PARCEL SIZE �•S V �. �' <br /> OWNER NAME C 1—I e' t–�r PHONE(S-1 <br /> OWNER ADDRESS S A VV% Cr1Y/STATEZP <br /> CONTRACTOR L J C 0 PCV' GC-0 e7 J VNO-ciN MEN'f t`t'I` PHONE I <br /> CONTRACTOR ADDRESS 4y-j w • V AK ST. CITY/STATEIZP L-0 D� � f7.1 Z't T 0 <br /> LICENSE ❑C-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 1BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ UFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft 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 /> IMUM 1i/ ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED !%9—1 TITLE C4I"Vir–fYT'NT DATE <br /> I E S <br /> SA V <br /> Ix <br /> I <br /> I I �d21 <br /> I <br /> I I I �/�Y <br /> 1 ENT <br /> ! DEPARTMENT US O L / <br /> Application Accepted By 1 Date 2/ Area / (7��mployee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> �z U 1 <br /> r 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />