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f � , <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)9953-7697 FOR INSPECTIONS EXP <br /> IRES 1 YEAR FROM DATE ISSUED <br /> 21*15 1w V CITY/ZIP "Pt <br /> JOB ADDRESS 6o - 42- <br /> CROSS STREET ►,^ APN �S—L 6O - L v y PARCEL SIZE �•�� <br /> d <br /> O <br /> J � <br /> OWNER NAME .5"teC/if yt�/� lV �J� /,�/P,HONEE O� / y <br /> OWNER ADDRESS-tw 0 5L `���_,C l/, �r CITY/STATE/ZIP/444 (/i- /S 9 y <br /> CONTRACTOR e-/? (50 �U� VL 'oJ/� ��L PHONE 9 6 -J� 7-` r/ 7 rl <br /> CONTRACTOR ADDRESS ���� �� L/ CITY/STATE/ZIP -/` C-7`Z��1,yUC. (%f. <br /> LICENSE ❑F'C-42 DIC-316 OTHER—/13 NUMBER lU-')72,7< EXPIRATION DATE <br /> WATER TABLE DEPTH:_ % ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I — PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 11 R PAIR/ADDITION IJ ENGINEER DESIGNED/ALTERNATIVE <br /> L.i REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM F.I 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 %2/7v `' gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLcc)�j ID) 1 <br /> —� ft FOUNDATION ft PROPERTY LINE -2_Tjft <br /> G LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES i... LEACHING CHAMBERS #OF LINES LENGTH OF LINES too ft <br /> DISTANCE TO NEAREST WELL: ft FOUNDATION�_ft PROPERTY LINE I ft <br /> El FILTER BED WIDTH ft LENGTH _ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE 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 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 /> S'ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR Ab 1' NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED L TITLE DATE "l.7 l 5 <br /> Pik)w <br /> SANJOAQUIN O N <br /> E i O M <br /> I F_ -FrFF <br /> rD ARTMENT SE N L Y /� <br /> y Application Accepted By Date � Area "/ Employee ID#464w_� <br /> 6s�, mal Inspection By Pate 14_tP� <br /> ERMIT-A rov b <br /> 5" 1if'atter of Soil to Depth of 3 Ft: ` P' Sump Soil �e�pp <br /> COMMENTS �/rfj£??� Q <br /> 6'for e5rp <br /> Ar"r� <br /> PE SC Received Check#/ mount Permit/ <br /> Code INFO —By Cash Remitted Date Service Re uest# Invoice# Permit ID# <br /> IF <br /> s►� _ <br /> orr�C A - V l vis .s a ; <br /> S -{i., h� r ,O��E WASTEWATER TRT T SYST M ER IT <br /> a2ai1alo/fs1lq Z ;rspe�k;,, 10i! lIti � r'" ©C� r r'�e�s C'• yi� 2/ <br /> 10/24f1 6.1 j -z/m" nsk�Il <br />