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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 5-s-&&1 w' KI L-t VL'D CITY/ZIP L-oo _`T7- <br /> CROSS STREET (2-AY rz-�>• APN O 0 1-2-* ("O PARCEL SIZE I`-I-) -Ac p <br /> OWNER NAME r V\A�Z-Y-- �V�Pt PHONE <br /> H <br /> OWNER ADDRESS S R G /� CITY/STATE/ZIP <br /> CONTRACTOR wJt 0AV- & .N � M <br /> c:a VIrzMe �L- PHONE 31v9- 03-1 r <br /> �t <br /> CONTRACTOR ADDRESS 1r"0, W . O Ar k- S'T' CITY/STATE/ZIP "T> 1 I L h �1 S-z�•I•(� <br /> LICENSE C-42 'C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 7C PERC TEST # l BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION I I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> G REPLACEMENT II 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 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It 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 /> INIMUM 224',H/OAR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /'tet TITLE C17/IS✓VT/t NT DATE y•-�— <br /> FFNT <br /> �vEo <br /> 15 2420 <br /> ARvTAL" Y <br /> NT <br /> DEPARTMENT US NLY <br /> qlqApplication Accepted L� L Date ZO Area Employee ID# �, t <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to pth Of 3 Ft: PiU ump Soil C aracter: <br /> COMMENTS C �D Q <br /> O <br /> PESC Received Check Amount Date Perm1U Invoice# Permit ID# <br /> Code INFO 0111,1 Remitted Service Re uest# <br /> Baa ssa3 01 Z <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />