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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46$3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITYIZIP 9_5-24_5'- <br /> 1 <br /> CROSS STREET_ya SCC] APN PARCEL SIZE <br /> Zoo-,3q <br /> d <br /> ! <br /> Z ° <br /> OWNER NAME AZ G"rMi7 PHONEI �/�S' ]OS-/DZ <br /> OWNER ADDRESS /�/ /nI � 7'L CrTY/STATEMP nl2rvV LLG <br /> // / <br /> CONTRACTOR ��rf hl/fz r/p�♦' �r• PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE #6.42 t C-36 OTHER NUMBER ySrJUS�S EXPIRATION DATE 0;7-3/-/0 i <br /> 1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION; Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L] NEW INSTALLATION _ REPAIR/ADDRION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT Il OUT-OFSERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ,�( COMMERCIAL LX4kyo ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> O SEPTIC TANK TYPEIMFG ikr v CAPACITY <br /> gal #OF COMPARTMENTS 1 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS 1 <br /> 1 <br /> DLSTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 1 <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES Ll LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft j <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft p <br /> ❑ MOUNDED WIDTH _ft LENGTH ft DEPTH ft Cy, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft T j <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It 4`( <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> SEEPAGE PITS NumBER WIDTH S I It DEPTH �St It <br /> DISTANCE TO NEAREST WELL �,,? ft FOUNDATION T1pw2 ft PROPERTY LINE S ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPUCATION 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 /> MINIMM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS/-PLEASE CALL(209)!9,5_3-7697 <br /> SIGNED TITLE ��.s� �/ DATE <br /> t <br /> t:. <br /> ff <br /> r r# <br /> i <br /> 11 <br /> EN <br /> L.. <br /> DEPARTMENT. SE NLY �,__,.,- __ <br /> Application Accepted 81C7 Date -7/2-0110 Area Employee ID# <br /> Final inspection B ! Date SPECIAL PERMIT-Approved by <br /> Character of Soli to a th of iFt: PiUSump Soil Character: <br /> COMMENTS ot-4 t_o7- OF aaF-co..4,D fcAJ-C /K"yo 4Ajk-7 L1—. S'AC(A-C- <br /> �f�xIT yaF-t(I-r(S) 1"aw {ol'Tzf O—uI <br /> I <br /> PE SC Received Amount Pennif/ <br /> Code INFO B Cash miffed Date Service Re uebt# invoice# Permit ID# <br /> 421-7 2.5s PI '(r -0n A600. DD "! . 2Gt0 d <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> Gl2w9 <br />