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y � <br /> Od ONSITE WASTEWATER TREATMENT SYSTEM-PERMIT, Cfi # <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT I CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 'C-2 CO-1 CITY/ZIP :::&4z9 C, <br /> y <br /> CROSS STREET V APN_;�4I 1110 — 3 PA RCE SIZE d <br /> OWNER NAME tC. ( U/II [� (� I _ i PHONE <br /> I OWNER ADDRESS _ O 0� I ( Li ✓! CITY/STATEIZIP G� <br /> CONTRACTOR _ `�C/� PHONE <br /> CONTRACTOR ADDRESS l[�� _�� I(n� CITY/STATE/ZIP <br /> r <br /> LICENSE * C-42 © C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordines X y <br /> L351 <br /> PERC TEST # BUILDING PERMIT# AND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION (3 -REPAIR/ADDITION O ENGINEER DESIGNED/ALTERNATIVE <br />+ REPLACEMENT ❑ DESTRUCTION - M <br /> INSTALLATION WILL SERVE: RESIDENCE E3 COMMERCIAL 13OTHER l l <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPFIMFGCAP ITY D g3] #OF COMPARTMENTS <br /> 13 GREASE TRAP TYPF/MFG C AC[TY gal #OF COMPARTMENTS <br /> i. DISTANCE TO NEAREST: WELL ft FOUNDATION f? PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE U �— �q❑ PKG TX PLANT S D OIL SEPARAT SED SYST M) <br /> LEACH LINES ,❑ LEACHING CHAMBE r/�r Y#0F S ti L GTH'O IN r ft <br /> f DISTANCE TO NEAREST WELL i ft FOUNDATI N l f PROP TY LINE ft <br /> ❑ FILTER BED WIDTH LENGTH DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft a <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ <br /> ❑' SUMPS WmTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION. ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL' ft' FOUNDATION 'ft PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE :ft <br /> I HEREBY CERTIFY THAT I 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 /> NIMUM 24 OUR ADV E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE r`J/ / <br /> l <br /> ! a IIY I I <br /> A <br /> 1 4 <br /> Y <br /> ti ! <br /> A a <br /> 11 V/11 rN <br /> - - M <br /> I <br /> D ARTMENTU E ONL <br /> Application Accepted , Date Area Employee 1D# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 Ft: it/Sump Soil Character <br /> CO TS <br /> tea, <br /> PE SC Received heck# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remifted Service Re uest# <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 05/30/2007 <br />