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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202-(209)46&3420 <br /> WON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADoREss JPS-k-- -T-ONr Jez7 ClTY21P S-1--V Cj<--rj r-J 'qS Z!37 <br /> CROSS STREETC.O Pt's R o PO Lt S ��• `T t12-r1--L)9 <br /> !! APN 1 a J^ PAyRCEJi 7-9-3 <br /> ry ySIZE d 3 �. I r <br /> OWNER NAME �Gl M >4fFP AJ S O PHONE <br /> C <br /> OWNER ADDRESS SP1-VV I CITYISTATE/ZIP <br /> CONTRACTOR Lt V C �tt' PHONE ` -7 <br /> CONTRACTOR <br /> TST, �t <br /> CONTRACTOR ADDRESS a)-7 1J, U CITYISTATEIZIP <br /> LICENSE i.�C-42 _';C$6 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 I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEWFG CAPACITY 921 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ UFT STATION SIZE TYPE OF PUMP U 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 WDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION It 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 /> MINIMUMXPOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE PJ2-D J CC- MCS!L . DATE <br /> Y �NT <br /> Lj <br /> 2 8 2OZ <br /> i NM�CoUNTy <br /> EPq" AL <br /> 'WeNT <br /> FPARTMEN�T I _QJyj-Y,,,l / I !t <br /> Application Accepted By T Date/ �f Are2 Employee ID# <br /> Final Inspection By J Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 FC PittSump Soil Character: <br /> COMMENTS <br /> PE SC Received hec Amount Permit/ <br /> Code INFO B sh Remitted Date Service Re uest#/ 1 j­4 - <br /> Invoice# Permit ID# <br /> 1�_(1� CINCITF V1ld CT>=INA TPR TRTAANT CVCTFIJ PFRA/1T <br />