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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> f SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE PAR[MLNI 600 E MAIN STH EET-STOCKTON CA 95202-(209)466-3420 <br /> ` <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> �. JOB ADDRESS 47-19 4.L • 3L-VCSpT�NE G • CITY/ZIP l��r o yf j-7-0 i <br /> CROSS STREET Lf:"STaNE �R.. APN O0S7- 5(00-01 PARCELSIZE 4.0t �• b <br /> OWNER NAME r f-cb Sr•ri, f�/,7P...NE,. �� 3 <br /> OWNER ADDRESS 2-Lf-240 /V . -SO►-7 LL S 02-Z) - 1 mCITY/STATEIZIP Ac P o C^�1p. '95-2-2-0- <br /> CONTRACTOR <br /> 5-2'2-0CONTRACTOR L I JC``�''''O� W AIr- &-C0C.Ajjyj 9 oNWtE�JTAL PHONE 3 b 9-O iI 5 <br /> 'IV <br /> CONTRACTOR ADDRESS -7 - O• •K 5T' CIN/STATE/ZIP <br /> LICENSE IC-42 I I.0-36 OTHER NUMBER ERPIRATION DATE <br /> WATER TABLE DEPTH; it 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 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION 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 /> INIM M 24,MUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 q <br /> SIGNED /` TITLE 6V 5%; t TITLE DATE <br /> YMENT <br /> CEIVED <br /> --- - - -- JN18 2019 <br /> QUIN COUNTY <br /> ONMENTAL <br /> DEPARTMENT <br /> U <br /> DEPARTMEN UE NL <br /> +, <br /> Application Accepted B Date Area Employee ID# c <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to f3 t: PiU ump Soil <br /> Character: <br /> COMMENTS L <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO A et Cash Remitted Service R uest# <br /> I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />