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UN511 t wA5 1 twATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 Z 3 S• t LLI S AI . CITY/Z:P 7io --r 4 `i S 317 !r,t <br /> CROSS STREET cKs�-�1e G-rC APN Z—t L0 — 13O- o� <br /> ' PARCEL SIZE f ��Q c p <br /> O <br /> OV/NER NAME �/�SJ I D E2 S I�U PHONE U31- 3 z.I C/ A <br /> N <br /> OWNER ADDRESS f �1 t1JlLDPL4i YYI !A� CrTY/STATE,ZP TPi-c 453-7�v <br /> CONTRACTOR �(Jt 01GL�t NV(R.DNrh t N f'r'(L PHONE 3 L 5— 03'1 S r <br /> CONTRACTOR ADDRESS 4Lf V1 l.lJ 0 fs1X— ST• CITY;STATEfZIP L-O D I CA <br /> LICENSE L,C12 =C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> �K PERC TEST 0 l i BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT Z DESTRUCTION <br /> INSTALLATION WILL SERVE: _ RESIDENCE = COMMERCIAL _ OTHER <br /> NUMBER OF LNING UNITS: NUMBER OF BEOROO1aS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/ivlFG CAPAC TY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPER 1FG CAPAC.TY gat SOF COMPAR'VEN—,S <br /> DISTANCE TO NEAREST: ft FCJNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ,7 PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES _ LEACHING CHAMBERS K OF L'NE9 LENGTH OF LINES R <br /> CE ENT <br /> DISTANCE TO NEAREST WE- ft FOUNDATION ft PP,CPER-Y L'NE ft VED <br /> ❑ FILTER BED WIDTH ft LENGTH !! DEPTH q <br /> DISTANCE TO NEAREST VE ft FOUNDATION ft PROPERTY L'%E •Jttf"! 1 20 <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH CA., [� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION PRCPERTY LINE fl- <br /> DISTANCE <br /> ❑ SUMPS WIDTH ft LENGTH ft ft <br /> YEAT �fONMEETA� <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft EPARTI►4ENT <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 AAD RULES AND REGULATIONS OF SANJOAQUIN COUNTY. <br /> IMUh1 24 Hfl01DkDVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED !�C TITLE PIZ163' M 612- DATE - f - Z o <br /> I I I <br /> 1 <br /> I I1 1 <br /> I � I <br /> I I <br /> I <br /> I i I II <br /> I I <br /> I <br /> I I I <br /> I <br /> I <br /> WITS <br /> ##, <br /> DEPARTMENT YSEONLY G <br /> Application Accepted By Gr G G Date U i I .701 Area S -I Employee IDS <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitJSump Soil Character. <br /> COMMENTS <br /> PE SC i Received I CheckW A Amount Permit!Code INFO Remitted I Date ServiceR uest a Invoice z Permit IDK <br /> yaa - <br /> a sa3 / 2`7 IS-1 1 S <br /> 42-0: ONS;-.E WASTEWATER TRTMNT SYSTEM PERMIT <br />