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f— -- <br /> zq�1 I <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT j <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET•STOCKTON CA 95202•(209)468-3420 <br /> NON-REFUND rT CA.LL 209 953-7697 FOR INSPECTIONS EXPIRES 9 YEAR FROM DATE ISSUED <br /> 4 JOB ADDRESS ' CITY/ZIP r �✓t- SZ2A U <br /> t ~ <br /> CRO55 STREET APN l=,X07— 3,�Q r 41 <br /> .,/ II�JKl I+ PARCEL-lSIZE <br /> OWER NM£ PHONE '3('7-M <br /> �� 5G4OWNERADDRESS CITYISTATE21P <br /> CONTRACTOR c ' Z �� <br /> pt' <br /> PHONE <br /> CONTRACTOR ADDRESS R= k� CITY/STATE21iL <br /> tq <br /> LICENSE WC-42 YA+C.36 OTHER NUMBER s!, i'ti a EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> :1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: E NEW INSTALLATION G REPAIRIADDmoN - ENGINEER DESIGNED/ALTERNATIVE <br /> i� REPLACEMENT O OUT-OFSI IGE SEPTIC SYSTEM C DESTRUCTION <br /> INSTALLATION WILL SERVE: ,RESIDENCE = COMMERCIAL O OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ✓ NUMBER OF EMPLOYEES: <br /> SEPTI:TANK TYPEJMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> • 4�/ �^1� 'pJ <br /> ( LEACH LINES � / <br /> LEACHING CHAMBERS � #OF LINES + LENGTH OF LINES / ft fY{rV <br /> DISTANCE TO NEAREST WELL *+ft FOUNDATION © ft PROPERTY LINE ft I't <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It 1 <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 R PROPERTY LANE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION�ft PROPERTY UNE ft <br /> SEEPAGE PITS NuuBER WI H c�R DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> i <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 /> M 24CE REQUIRED FOR ECTIQ P 5E CALL(209 t3-7 <br /> 7 <br /> SIGNED ,91J '' yy//FF DATE lam' �iL <br /> I I <br /> TF 11 <br /> t <br /> WENT <br /> J x I R QE VED <br /> ( J <br /> N(;OUNtz <br /> 1 <br /> DE TMENT . <br /> I I 1 <br /> _ DEPARTElIT .E NLY ��--.� - <br /> Application Accepted - _y - Date Area Employee ID# 5�4 g�f <br /> Final Inspection B Date _� L SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitfSump Soil Character: <br /> COMMENTS [QcZ L c7=nF �Lo� <br /> PE I SC Received ChecktN AmoOnf Date - Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted I Service Request# <br /> _ 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMfT 1 <br /> 6126109 <br /> i <br />