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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HA2ELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209953-7697FORINSPECTIOIdS EXPIRES 1 YEAR FROM DATE ISSUED <br /> FOWNER <br /> SS O ° -CITY/ZIP / )�� <br /> Z, <br /> ET UE.!� ApN P DD PARCEL$12E -`- '-' <br /> E .f✓(j.`'C- .7� �, _PHONE <br /> M <br /> RESS / CITY/STATE/ZIP <br /> CONTRACTOR /�TI -/ L ¢ c 5;fuj e•/'1 -' <br /> PHONE <br /> CONTRACTOR ADDRESS df^ C17Y/ST <br /> ATE ZI_P.-_ 9 <br /> LICENSE E)C•42 OC-36 OTHER Gt <br /> /. / 12 EXPIRATIONDATE /- '7dZ!J3�Z�liz_ <br /> WATER TABLE DEPTH: 1 O It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: D NEW INSTALLATION I REPAIRIAODITION L. ENGINEER DESIGNED/ALT RNATIVE <br /> 1I REPLACEMENT .1 OUT-OF-SERVICE SEPTIC SYSTEM L DESTRUCTION - "� <br /> INSTALLATION WILL SERVE: J RESIDENCE H COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:— <br /> SEPTECTANK TYPE/MFG Pf'l �/U4� CAPACITY ��-'-�� gal #OFCOMPARTMENTS - <br /> ❑ GREASE TRAP TYPEJMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP L3 P KG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES LEACHING CHAMBERS S"q,�y JOA/!, . #of LINES_ — LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE It <br /> /X FILTER BED WIDTH_13 It LENGTH T9 ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE �2 ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION Il PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH P4VA�1ll1T ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPER T'. `7��ft <br /> ❑ DISPOSALPONDS WIDTH It LENGTH ft DEPTH � q It <br /> DISTANCE TO NEAREST WELL . It FOUNDATION It PROPER 4 1 L 0 i„.It <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH SAN )gAD�� ft <br /> Ty <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PR EFN�4Ai&7n.gBL,/7-�=N ft <br /> [HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN biftfUN <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED�' G r-- _ TITLE_[' �r-J / DATE <br /> x <br /> DEPARTMENZ JS&ONLY ,— <br /> Application Accepted By to-- Area Employee IDN A"sl Il 17L� <br /> Final Inspection By Date a z ❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft: P t/Sump Soil Character: <br /> COMMENTS S S 'it, k!!i- I ('ypp±ib][an1 <br /> PE SC Received I Chec Amount Permit/ <br /> Code INFO B se h Remitted Dat¢ Service Re Uest# Invoice# Permit 10# <br /> 42-03 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24112 <br />