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ONSITE WASTEWATER TREATMENT SYSTEM PERMI I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46II-3420 <br /> NON-REFUNDABLE PERMIT J ry f CALL 209 953-7697 FOR INSPECTIONS +r EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS f Z•-i+4,. J ii -"�`.7rh L•-• �^ � ' `1t;,1ai �.,,,3�''J° C11Y1ZIP L-C r✓ I "'I J ;-;40'ZJ to <br /> CROSS STREET to �Y J qq y � z ` '°� ` > <br /> 7 1 i .���'� may.,, APN V�"�� "I(1 pP�A�RCEL}SrLE <br /> OWNER NAME v t"C� -C bo V 1nS �p PHONE(I;2st) r) <br /> OWNER ADDRESS ) � j7 � "7 �-•,J. CITY)STATFJZIP <br /> CONTRACTOR L-i VC L+�YtC- t'sC Of- "•y iviyJ+I- -t�!`jf 1WN 1 �- PHONE ii%"I <br /> CONTRACTOR ADDRESS ;4,)-1 t,,;, C T L L.- I CITYISTATEILP <br /> LICENSE QC-42 CC-36 OTHER NUMBER EXPIRATION DATE _ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 4K PERC TEST #-_-L— I BUILDING PERMIT# LAND USE APPLICATION# �� <br /> TYPE OF WORK: C NEW INSTALLATION a REPAIRIAoornoN C ENGINEER DESIGNED IALTERNATIvE <br /> C REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE r COMMERCIAL [3, OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> O SEPTIC TANK TYPE/MFGCAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY 931 #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE _TYPE OF PUMP ❑ PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES Lli LOLE <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft R FIVE <br /> (3 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION _,- It PROPERTY LINE it <br /> ❑ MOUNDED WIDTH_ ft LENGTH It DEPTHyyy.ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPS. NE—�, ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH Tft <br /> DISTANCE TO NEAREST WELL --�ft FOUNDATION ft E Nl`0*C MF N_LA I HE A L It <br /> ❑ DISPOSAL PONDS WIDTH_­_, ft LENGTH ft DEPTH-P- — 5 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ _ft PROPERTY LINE- ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH_—_ ____ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE 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 /> NIMIMUU 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ✓L "t- r✓ TITLE 7�P'c J C t 7 /YI ZL f' DATE _ f L4-2 �, <br /> t <br /> i <br /> �� ,([a }1; AtMa+wD pasodad . } <br /> PAYMENT� <br /> { <br /> All <br /> 5 = Y <br /> 28 2020 <br /> �OROUIN CDDNTY <br /> LTN DE gRT1yENT <br /> D PARTMENLU ..O gL <br /> Application Accepted By_ Date a Area �r EmployBe ID# WI^ <br /> Final Inspection By _ _ Date —_ I SPECIAL P RMIT-Approved by <br /> Character of Soil to Depth 3 Ft Pit/Sump Soil Character:. <br /> COMMENTS <br /> PE Sc Received Chec Amount D to J Permit/ Invoice# Permit ID# <br /> Code INFO Remitted Service Re st# <br /> _._... -77 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />