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clG ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIR S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /0 ' log (} <br /> CROSS STREET G lY/i <br /> /j/ APN 1 o_/ ' On" PARCEL SIZE Z�. .�-- o <br /> OWNER NAME �� T PHONE <br /> OWNER ADDRESS yfCrTYISTATEJZIP <br /> CONTRACTOR / 1/���1 Y-�i.'�t�/, .�^ �i'-t,A::�G PHONE <br /> CONTRACTOR ADDRESS J ��� �� CITY/STATE/ZIP <br /> LICENSE .12 �C-36 OTHER NUMBER A`X/!3� EXPIRATIONDATE <br /> WATER TAAB''LE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> J PERC TEST # BUILDING PERMIT# b Z LAND USE APPLICATION# <br /> TYPE OF WORK: NEW IHSTALLATKIN LI REPAIR/ADDTf1pN r ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT = DESTRUCTION <br /> INSTALLATION WILL SERVE: f RESIDENCE U COMMERCIAL r� LOTHER <br /> NUMBER OF LIVING UNITS: /,O / NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG / (- CAPACITY /,/60 gal #OF COMPARTMENTS <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG <br /> DISTANCE TO NEAREST: WELL ,'J'r - ft FOUNDATION �0 ft PROPERTY LINE �7 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 7 LEACHING CHAMBERS � #OF LINES LENGTH OF LINES <br /> [/ DISTANCE TO NEAREST WELL Jam0/'4_ft FOUNDATION 14� _ft PROPERTY LINE Ste- ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ sumps WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION _ ft PROPERTY LINE _ft <br /> SEEPAGE PRS NUMBER <br /> / <br /> W DTH Y/ �I ft DEPTH-9 � ft <br /> DISTANCE TO NEAREST WELL l�l _ft FOUNDATION 1"0/ ft PROPERTY LINE 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 /> MIN 24 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209)953-7697 /J <br /> SIGNED'. 42' /.l TITLE IF <br /> DATE <br /> T' <br /> +r r r <br /> i <br /> r I I <br /> 7 <br /> C <br /> f <br /> • 1 i <br /> I <br /> i <br /> P Y E T <br /> JO DUI C N7 <br /> TH DE RT EN LL <br /> PARTMENT psE LYT�'g/► <br /> Application Accepted _ Date n1 fl Area Employee ID# ! <br /> Final Inspection Date L SPECIAL PERMIT-Approved by <br /> Character of Soil to De !h of Ft: Pit/Sump Sail Character: <br /> COMMENTS /7LD GIOf OF IwCYfLd <br /> PE SC Received Che Amount Date Penn1U Invoice# Permit IDS <br /> Code INFO B ah emitted Service R vast# <br /> Z// / z ' I r 1 z3 <br /> 1F <br /> 1 <br /> '2-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1010107 <br />