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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLEPERMIT <br /> r�CALL(209 953-7697 FOR INSPECTIONS EXPIRESp1 YEAR FROM DATE ISSUED <br /> JOBADDRESS Z t ` C�'v /��' CITYZP -T��.y r 5-7704 p � <br /> CROSS STREET - APPNN 2-5'57- 07-07/�(�,�/� <br /> PARCEL SIZE �• 1 >�• p <br /> OWNER NAME GYt 1f,j�..`N`� ITT/��VTL'-�{Z, I�/J!i�i7�� (%'VC�ii-.W - P�H7ONNEE./ bU 7z S OO'IjQ �j gni, <br /> OWNER ADDRESS -r3� r0 N 7 +` /� "�L'�� CIN/STATE/Z1P TI-`y" "1 CA /� T <br /> CONTRACTOR L'1y C ^� G"EOENVI(40AjW'EAj I AL— PHONE— <br /> CONTRACTOR <br /> b`I <br /> CONTRACTOR ADDRESS 1+0-1 w- 0 A114- S 1 CITY/STATE/ZIP t-C70 1 U� <br /> LICENSE ❑C-42 ❑C36 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: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG 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 2 LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE To NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE R <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 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 q <br /> SIGNED _ TITLE C 6n1s v�T� DATE <br /> VICINITY MAP <br /> 3�iv <br /> W ema <br /> \M <br /> ;omaAQ 020 <br /> H III I I I I 11111111 MI if <br /> 7,�R�NM��U TY <br /> ENT <br /> DEPARTMENT �1ONJN <br /> Application Accepted B Date �/ �"� Area *IALPIR.IT <br /> Employee ID# <br /> Final Inspection By Date ❑ SPE -Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE Sc Received (Check#/ Amount Date Permit/ Invoice# Permit IO# <br /> Code INFO B Remitte Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />