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s <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT GALL ZU9 953-7697 FOR INSPECTIONS ' EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS IIII f f�l/U Y L CITY/ZIP _,�`[r- <br />y/ CJ/�-/ <br />CROSS STREET/ , APN (-9R 7 ZO 0 SPARCEL SIZE (D- <br />L <br />OWNER NAME l'x 911--in-11 <br />� PHONE <br />OWNER ADDRESS (�16 / r Tytg" /�( %/W /�CIN/STATE/ZIPI , u i// z/ /_'- <br />CONTRACTOR -4 L G-0 G 0 �/% ilf -711-'41= 2 PHONE Y l k1 C - U q1V /- �j <br />CONTRACTOR ADDRESS 41.=)Si OTWELL Sf: CITY/STATE/LP SA-4);Qk �iC i&-A-�. 7L7// <br />LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBERSRO!� Z EXPIRATION DATE b �O'Z02-I <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />BUILDING PERMIT# <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />U NEW INSTALLATION U <br />REPAIR/ADDITION <br />U ENGINEER DESIGNED/ALTERNATIVE <br />• • • PROPERTY <br />❑ REPLACEMENT ❑ <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />❑ DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />• . TH <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />■ SEEPAGE PITS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />I ❑ PKG TX PLANT O <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />■ LEACH LINES <br />■ LEACHING CHAMBERS #OFLINES—• <br />DISTANCE To NEAREST WELL— It FOUNDATION III PROPERTY LINE <br />ft <br />■ FILTER BED <br />• -TH <br />ft <br />• • • PROPERTY <br />Ll MOUNDED <br />DEPTH <br />DISTANCE To NEAREST• .• PROPERTY <br />• . TH <br />ft <br />• • PROPERTY UNE_ <br />ft <br />■ DISPOSAL PONDSDEPTH <br />DISTANCE To NEAREST WELL_ It FOUNDATION ft PROPERTY LINE <br />It <br />■ SEEPAGE PITS <br />NUMBER WIDTH • . TH <br />ft <br />DISTANCE ToFOUNDATION <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 />AIKIM_UM <br />48 HOUR ADVANCE NO REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7097 <br />P <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />• <br />• <br />�i 4y �' r/ / ��t fes/ <br />!� Valle <br />'42-01 <br />ONSITE WAffrj�Tjffi SYSTEM PERMIT <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH nPPARTMFNT <br />