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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 800 E MAIN STREET - STOCKTON CA 95202 - (209) 488-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR InsPECTfons EXPIRES 1 YEAR FROM DATE ISSUED <br />I JOB ADDRESS <br />C)TY/ZIP .S -Ark <br />CROSS STREET 'yj v_At-l- APN PARCEL SIZE <br />OWNER NAME,_A11�",f1° _PHONE <br />OWNER ADDRESS �T CITYISTAT£1ZIP r� _.._.._._.. ....._..._......_. <br />CONTRACTOR �„- Y C PHONE I - �jc!2 - <br />CONTRACTOR ADDRESS CITYISTATEOP _ <br />LICENSE7�'a.-42 1C-38 OTHER NUMBERJTo yf EXPIRATION DATE <br />WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST It I_. BUILDING PERMIT # LAND USE APPLICATION At <br />TYPE Dl V17ORI( -NEW INSTALLATION / R_�EPAIRiAD04TION ENGWEER DESIGNED /ALTERNATIVE <br />REPLACEMENT ' t.i OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />--.._-.—.___._.. _..—_._....__._.....___.._.,_..._._..__-___..-......._...____ ....... ._.__.--.—__. .......... <br />INSTALLATION WILL SERVE: I. RESIDENCE COMMERCIAL L OTHER <br />NUMBBR OF LIVLNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />..............._...._._....._......_.__........_..__...._..._..,..._._.._-_°.••-..--^.z-.-..:-.._..._..._._...._..............._..__._.... ._.. ^- ._.__ <br />Cl SEPTIC TANK TYPE/MFG _ �- CAPACITY g81 # OF COMPARTMENTS __,,,,,_,_„__,_ _ <br />LI UREASE TRAY TYPE%MFG _ _ CAPACITY U8i * OF COMPARTMENTS __­_ <br />DISTANCE TO NEAREST: WEI t f< FOUNDATION ft PROPERTY LINE It <br />C1 LIFT STATION SIZE - � TYPE OF PUMP U PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />_.. _ _........... ._...._ _.._........__.-.._.._.,_._....._......._._._......,__.__._.__._..�..___._.-_.___.._... .... .... ,...... ..... <br />...._... <br />LEACH LINES LEACHING CHAMBERS # OF LINES _ .3_ _ LENGTH OF LINES It <br />r r I%O <br />DISTANCE TO NEAREST WELL ft FOUNDATION FOUNDATION IONS R PROPERTY LINE fl <br />CI FILTER BED WIDTH _It LENGTH ft DEPTH _tt <br />DISTANCE To NEAREST WELL _-ft FOUNDATION It PROPERTY LINE— fl <br />• MOUNDED WIDTH It LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE K <br />• SUMPS WIDTH. _ It LENGTH - _ - � _. „ It DEPTH - It <br />DISTANCE To NEAREST WELL _,_,,,,,,-,_,_-__,__ft FOUNDA11ON ft PROPERTY I.INE_ ,,,_,.,,-,_,_-.fl <br />O DISPOSAL PONDS wNTTH__. h LENGTH it DEPTH, -ft <br />DISTANCE To NEAREST WELL - ft FOUNDATION It PROPERTY�.INE fi <br />! <br />SEEPAGE PITS NUMBER k WIDTH ..5 _ It DEPTH �_ �I r i_ -tl <br />DISTANCE TO NEAREST WELL JALT B R FOUNDATION I Ctl} It PROP,R rY LINE„-�� R <br />1 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 />MINIMUM 24 HOURD A E NOTICE REQUIRED FOR INSP CT10N - PLEASE CAL 209 933-769 <br />SIGNED /1..�'J - TITLE fQ1r DATE G 1; Ax� <br />Application Accepted " <br />�.� <br />Final inspection By <br />Character of Solt to Detft of 3 F <br />COMMENTS <br />Date _ �- Area employee ILNr <br />Date7�j'� L SPECIAL PERMIT - Approved by- <br />_ P1USump Solt Character: _ <br />-4 <br />T--- - <br />�- PE r� Recelved��-' <br />L • <br />-Aroaunt Pern It/ Invoice 0 <br />OxRe Service <br />Permit ID# <br />--- <br />�� <br />9t�M:PN-° <br />A <br />1• <br />_��ll <br />Ri <br />■���urslc-sem <br />N <br />.I <br />■ <br />■ <br />� <br />ASL <br />x■ <br />=- <br />�:7 <br />■ <br />V■ <br />..” <br />NR <br />Application Accepted " <br />�.� <br />Final inspection By <br />Character of Solt to Detft of 3 F <br />COMMENTS <br />Date _ �- Area employee ILNr <br />Date7�j'� L SPECIAL PERMIT - Approved by- <br />_ P1USump Solt Character: _ <br />-4 <br />T--- - <br />�- PE r� Recelved��-' <br />.._.__. <br />CheCk#i <br />-Aroaunt Pern It/ Invoice 0 <br />OxRe Service <br />Permit ID# <br />--- <br />42.0i ONSITE WASTEWATER 'TRTMNT SYSTEM PERMIT <br />Wwfa <br />