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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 PERMIT` w CALL 209 953-7697 FOR INSPECTIONS PDT-) <br /> 1 YEAR FROM DATE ISSUED <br /> M <br /> JOB ADDRESS A RMlamas&A ETC CITY/ZIP 0-1 p VN - <br /> �i <br /> CROSS STREET 64i"(rli"j 'Q It r � APN i-,4 T-- 0(a O- .3'1 PARCEL SIZE 1'I •`" > <br /> 0 <br /> OWNER NAME F'xy PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR L(�r �K G.I A <br /> V tNVV1 Rry <br /> VN ENTAL PHONE ?(Pq <br /> W <br /> CONTRACTOR ADDRESS T v-7 - 0- -Y— 5T' _ CIN/STATE/ZIP L 0� G� 1 Y2-14 d <br /> LICENSE I.:C-42 I_,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> �C PERC TEST # FBUILDING 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 ft FOUNDATION ft PROPERTY LINE It <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 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 WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1MUM 24 H VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 2 I <br /> SIGNED TITLE GQN�V l..'r1Pt N'^� DATE J-'1 0 <br /> RFq�'MF <br /> CFjV�T <br /> 0?0 <br /> iN <br /> Op FNov/�rY <br /> �RrMFNr <br /> III DEPARTMENT USE ON Y <br /> Application Accepted Daten^ Area Employee ID# <br /> Final Inspection By Date_ W C SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: P Sum Soil Character: <br /> COMMENTS Irw rr �nc�t. <br /> PE Sc Received ec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted I Service Request# <br /> ZZZ Z2y <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />