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r".F', ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NoN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I Y AR FROM DATE ISSUEri <br /> JOB ADDRESS C CITY/ZIP <br /> CROSS STREET r APN L� r G� �— PARCEL SIZE d <br /> O <br /> OWNERNAk1E 41&ez�1j2dI ✓ PHONE <br /> OWNER ADD%,?,SS CITY/STATE/ZIP <br /> CONTRACTOR /� rt� }G PHONE ��—f 'y <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP a�i 7/1r rV'J S <br /> r <br /> LICENSE C42 7 C 36 OTHER NUMBER� �� � ExPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 13 NFW INSTALLATION REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE <br /> O REPT.ACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL 0 OTHEB <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> O GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP CI P1cG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES O LEACHING CHAMBERS #OF LINES LENGTH OF LINES � ft <br /> DISTANCE TO NEAREST WELL Q f ft FOUNDATIONS/4 ft PROPERTY LINE + ft <br /> C7 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL, ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH ft DEPTFI ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE _ft I� <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ <br /> SEEPAGE PITS NUMBER WIDTH _ ft DEPTH I J_ $ <br /> v DISTANCE TO NEAREST WELL ft r'OUNDATION _ L'J + ft PROPERTY LINE 1j R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIKW24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- LEASE CALL(209)953-7697 <br /> SIGNED %r TITLE_ 9/ DATE <br /> rFT <br /> ` 1 <br /> 1N -,01 Ir1 <br /> V Vil O M <br /> DEPARTMENT US O LV <br /> Application Accepted/Byyy,,, Date 5 t � Area Employee ID# r4 Y <br /> Final Inspection f = 2 Date '��/it's' 0 SPECIAL PERMIT-Approved by <br /> Character of Sail to D.Oth or3 Ft: Pit[Sump Soil Character: <br /> COMMENTS C I~aJ L_p T c F <br /> PE SC Received C Check#! Amount Permit/ <br /> Code INFO B as Remitted Date ervice Re ues Invoice# Permit ID# <br /> 0 0 Sct <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 05/30/2007 <br />