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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 PERMIT1 CALL 209 'I 9$3-7697 FOR INSPECTIONS EXPIRES YEAR FROM DATE ISSUED <br /> JOB ADDRESS I -1 391-4 E. t-f20/VT ST. CITY/ZIP <br /> CROSS STREET (I�C I C�-A� L Cr� APN "�0 ( - 1 c) — PARCEL SIZE J• Z o <br /> OWNER NAME '1>1 PCN A �` '� 1 "Plr`t��GN L t-C% PHONE el - co—)co C <br /> OWNER ADDRESS J �> c, { CITYISTATE/ZIP <br /> V! <br /> CONTRACTOR lit V,,0 /J �-\1F- I.—G OU,"MI��W1 /�I— PHONE 319 1- 03-7 5- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS TD I ✓�' O�'�1` CIN/STATE/ZIP Lca>I cit -1 4O <br /> LICENSE I C-42 I_C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # FNIJILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAWADDITION 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH It 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <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 It 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 /> INIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE e_ZAISVL7Y1--T_ DATE Z 2I 2Ci <br /> Nr <br /> Z­Rg"M FA <br /> 20 <br /> Nn. <br /> r <br /> SK <br /> -�S <br /> DEPARTME T SE O LY <br /> I IAJII�AA J Y . A�7.11,*zn <br /> Application Accepted Date Area Employee ID# <br /> Final Inspection By Date �� Sp <br /> ECI L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft. Pit/Sump Soil Character: <br /> COMWNT <br /> Y'h :i-t <br /> PE SC Received hec Amount Permit/ Invoice# Permit ID# <br /> Code INFO B Date ash Remitted is uest# <br /> I�_may n <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />