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9x <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202 -(209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS /�/ b CITY/ZIP S <br /> AIP <br /> CROSS STREET G\ T"e"r AP\ ', (] PARCEL SIZE J o <br /> a <br /> OWNER NAME 0 Itr n K.r l S PHONES <br /> OWNER ADDRESS j t In C 31d n 64 CI1/STATE/ZI1 C ) �� <br /> CONTRACTOR <br /> PHONE <br /> CONTRACTOR ADDRESS k Q CTfY1STATFJZIP C <br /> LICENSE ZI C-42 ❑C-36 OTHER !NUMBER EXPIRATION DATE - <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BPERMIT# 4{ <br /> UILDING LAND USE APPLICATION# <br /> TYPE OF WORK: W NEWINSTALLITION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT J DESTRUCTION <br /> �I'NSTALLATIONWILLSERVE: EKESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVINGUNnS: �� :NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q//SEPTIC TANK TYPE/MFG Tr '1 L— CAPACITY _ gal #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPEMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATIONft PROPERTY LINE_ c� ft }--. <br /> ❑ LIFT STATION SIZE TYPE OFPGMP ❑ SAND OIL SERA BATOR(ENCLOSED SYSTEM) V <br /> Q-/LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES 440 ft <br /> DISTANCETONEAREST WELLI I�T1 ft FOUNDATION )Q ! h PROPERTYLI.VE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> Dis TANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED Www ft LENGTH R 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> / 1 <br /> DISTANCE TO NEA RF ST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> _ <br /> >y SEEPAGE PITS NUMBER" _.._WmTR 3 6 k ft DEPTH 25— R <br /> r fl <br /> DISTANCE TO NEAREST WELL ,`La I ft FOUNDATION I ft PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM.4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL('-09)453-7697 <br /> SIGNED J TITLE GaY,-1-tDATE <br /> i <br /> if <br /> U <br /> v I <br /> I <br /> 3' <br /> 9 � <br /> Ij` t <br /> I <br /> 1 I <br /> DEPARTMENT U. ON Y <br /> Application Accepttd 3 - - to U� Area _ Employee ID# <br /> Final Inspection By <br /> Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth 3 Ft: i/JSump Soil Cha r:_ <br /> COMMENTS �� (�- .� 1!7 -19 <br /> PE SC Received Amount !/ Pez" Involve# Permit ID# <br /> Code INFO Remitted ate Service R Dent# <br /> p ,t s�Ooq oa5 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12!2212003 <br />