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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 93202-(209)(663620 <br /> NON-REFUNDABLE PERMIT CALL 209 9S3-7697 FOR INSPECTIONS EXX-P.IRESS 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS I6-10 G. y%^CLTtf-j CITYRJP M�����"7 4 23 <br /> CROSS STREET r•`�/�-�j-IiL CC A t`i'> APN Z l PARCEL SIZE <br /> OWNER NAME LM"\" • '-"—C� k 6— PHONE cpI-2' _OI 3 - r^ <br /> OWNER ADDRESS I 0 "'7 S?/ R CT'/STATEIZP 1^�hw C'A 9 6334 <br /> CONTRACTOR_ L Iy G�LOp\�Kl Ot.1" IfLy . NSI_ _PHONE <br /> CONTRACTOR ADDRESS -T"�. t'`7 Cf -�T CITY/STATElL -0�► 1 ( C.� �L S .40 <br /> LICENSE FC-42 '_JC36 OTHER NUMBER EIVIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ,C PERC TEST B 1 BUILDING PERMIT# LAND USE APPLICATION II <br /> TYPE OF WORK: C: NEW INSTALLATION 7 REpAiPJADOPTION _ ENGINEER DESIGNED(ALTERNATIVE <br /> I: REPLACEMENT DesTltucnoN <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNIT$: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYmMi,G CAPACITY flat B OF COMPARTMENTS <br /> ❑ GREASETRAP TYP"FG CAPACITY pal B OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS B OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST HELL R FOUNDATION It PROPERTY LINE ft <br /> O FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DoTANCE TO N9ARE.3T WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> Cl SUMPS WIDTH ft LENGTH R DEPTH <br /> DISTANCE TO NEAREST AELL _R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEME3T WELL I. FOUNDATION R PROPERTY LINE ft <br /> 1 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 /> NIMUM 24 HQ�J[GADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �(L--P TITLE P�-�. 2 DATE If I <br /> t <br /> I i7 <br /> I <br /> I I <br /> I <br /> I <br /> I I i <br /> I y <br /> CF VNT <br /> i Q <br /> 1 <br /> I 5 ?D?0 <br /> /N <br /> C01'. <br /> A 1?' <br /> �7 7 DEPARTMENT E O LY �. ARJ'MENT <br /> Application Accepted By �— ��' L Date 2 Area f C Employee IDB sem_ <br /> Final Inspection By Date Li SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PWSump Soil Character. <br /> COMMENTS <br /> PE SC Received her. Amount Portrait/ Invoice B Permit IDB <br /> Code INFO B ash Remitted Dau Service Request B <br /> as sa s I , ( �,zI <br />