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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPI ES I YEAR FROM DATE ISSUED <br /> JOBADDRESS � CrrY/ZIP <br /> CROSS STREET /1��YI��'C. APN Q?7- ! :JL' ' [ f PARCEL wr ? O <br /> `` XIX p <br /> OWNERNAME �FsC 1L7�41 V� PHONE <br /> OWNER ADDRESS Ste/�'"' CITY/STATVZIP rX <br /> CONTRACTOR PHONE 36 CN3 <br /> CONTRACTOR ADDRESS CTTYISTATE/Z �. <br /> LICENSE -42 ❑C-36 OTHER NUMBER EXPIRATIONDATE ' <br /> WATER TABLE DEPTH: �/�� R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: `` IDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> }O�SEPTIC TANK TYPEIMFG nLC / ¢ L- CAPACITY gal #OFCOMPARTMENTS <br /> (❑ CREASE TRAP TYPE/MFG Tom' CAPACITY_40er��,�50 #OF COMPARTMENTS <br /> i <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL 'C:3T ft FOUNDATION�S/ ft PROPERTY LINE R <br /> ❑ LIFT STATION SIzE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES CZA LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL SdT ft FOUNDATION �n R PROPERTY LINE S I ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 99 IDTH S' ft DEPTH <br /> DIsrANCETONEAREST WELL liOC-)' ft FOUNDATION ft PROPERTY LINE ft <br /> I HERE ' 'tTIFV THAT 1 HAVE PREPARED THIS LICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STAT LA S AND RULES AND REGULATIONS OF SAN JOAQUN COUNTY. <br /> 1 1 24 OUR ADV. C REQUIRED FOR INSPECTIONS-PLEASF,CALL(209)953-7697 <br /> SIGNED TITLE—7P�'' - DATE4K I II I <br /> i 0 <br /> r7 F <br /> I I \L 11r <br /> I <br /> v � <br /> i <br /> t <br /> .P PARTMENT S ON <br /> Application Accepted . 2j� <br /> -.Date Area EmployeeID# <br /> [3 <br /> Final Inspection B atc SPECIAL PERMIT-Approved by <br /> Cbaracter of Soil to Dept 3 t/S <br /> FC PiUmp Soil Character: <br /> COMMENTS C(D —Lor !Sr REC,9EM '/UE—rJ fZA/L�"(/C£ �I S��r 92aZ1 741-46701 <br /> PE SC Received Cheek#/ Amount Permit! Invoice# Permit ID# <br /> Code INFO B as Remitted Date Service R nest# <br /> SRo <br /> 42-02.001 ONSITE WASTEWATER PERMIT <br /> 12222003 <br />