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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 <br /> C PERMIT. / C CALL 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS O `T• 7' DI3CP-TS �' CITY/ZIP CnVC)e-TVr'j g577'o IG -� <br /> -1 <br /> CROSS STREET 4V APN - �U - PARCEL SIZE ��-S > <br /> �1 l ` O <br /> OWNERNAME ,r, �7C w�t�y PHONE Offsz --)g "17 /D <br /> OWNER ADDRESS 3-7/4 CfSrt9- C Hl i'V EZ ST. CIN/STATE/ZIP SA n/ Fi""C l i CO C'A '914110 <br /> CONTRACTOR LtVt- OAIL Gtot:��V)9-0r.1MCA/TRL PHONE 3LDGI`03-15'- <br /> CONTRACTOR <br /> , SCONTRACTOR ADDRESS Afo-7 O At` 5T• CITY/STATE/ZIP L-0-01 C-A 1S'7-q0 <br /> LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I i NEW INSTALLATION I7 REPAIR/ADDITION I i ENGINEER DESIGNED/ALTERNATIVE <br /> ;.I REPLACEMENT (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 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 ❑ PK.G TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES i LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE To NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <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'2/f)IDUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /- TITLE L�NSyl�T1�^1� DATE -&- 7 <br /> E yMEAir <br /> CE�Vi�D <br /> N PR 23 ?020 <br /> T RONMECOUNTy <br /> DFpgRT41 L <br /> H M E <br /> —H4 t <br /> NLY <br /> Application AcceptedAy —7o(� DEPADate qT 23 ZIUSE v Z'o 3 <br /> Area �/ 7 Employee ID# DA <br /> Final Inspection By Date 7-0 70 SPECIAL PERMIT-Approved by <br /> Character of Soil J�Depthf 3 t: u <br /> Pitimp Soil Character: <br /> COMMENTS f�'6o A r S. ; <br /> PESC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO sh Remitted ServiceRe uest# <br /> L►aaa �a3 D I -d 23 Z� 00 <br /> 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />