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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE <br /> ff PERMIITCAALnL.x209 953-7697 FOR INSPECTIONS y�E�X� �i <br /> P 'I <br /> EXPIRES YEAR FROM DATE ISSUED <br /> !. JOB ADDRESS "'!'2 ``t9 G. VEST✓r`�� G'1 CITY/Zip ACA'Ai PIC) /f7-2D <br /> CROSS STREET LE:"$-rDNC J�Fx' APN dOS' 56PO-0't PARCELSIZE 4-of At. Y <br /> d <br /> j p0 <br /> OWNER NAME �!`�G V S! 1I� PHONE 37-9 - 3-)1 O Ci <br /> OWNER ADDRESS ?''t–I 7�y C�� /V `-.S'O 1�QL^L S I'�"'-' CITY/STATE/ZIP IRcAJYYI�r D <br /> cit IS-2-2-o <br /> CONTRACTOR LI JC 6T1— GL0Tp-Aj✓Ije-o--Nm�fTAL PHONE 3bef-013-)S <br /> CONTRACTOR ADDRESS 4o1 41J . OAK 51. CITYISTATE/ZIP LbyI C.r1' � <br /> LICENSE ❑C-42 CIC-36 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 C 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 /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R 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 #OFLINES LENGTHOFLINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it <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 LINE It <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 2244MUUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209)953-7697 p <br /> SIGNED /`"" ` TITLE &yW5Vt IA^jT DATE <br /> 4YMENT <br /> CEIVED <br /> 18 2019 <br /> QUIN COUNTY <br /> ONMENTAL <br /> DEPARTMENT <br /> 1-411 Y 1 1) 1 1 It, --- T-H] <br /> 11 <br /> DEPARTMEN U E NL / <br /> Application Accepted B Date 1 Area�� Employee ID#_ <br /> Final Inspection By Date U SPECIAL PERMIT-Approved by <br /> Character of Soil to f3 t: Pit, Limp Soil Character. <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date PermitInvoice# Permit ID# <br /> Code INFO Cash Remitted Service Re uest# <br /> I <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />