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C—)INSUE "'oA/ASTEVVAI"It�ZR 'YREATliF�EmN',,T SYSTEM PE—RMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209j 953-7697 FOR INSPECTIONS ExPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/71P <br /> CROSS S rR EET APN PARCEL SIZE_ <br /> OWNER NAME X 1z PHONE <br /> OWNER ADDRESSCITYISTATE/ZIP <br /> CONTRACTOR PHONE 2,10'j <br /> CONTRACTOR ADDRESS 1/0V CITY/STATEIZIP <br /> LICENSE FJI-IC-42 E1('IC-36 OTHER NUMBER ExPIRATION DATE <br /> W ( t <br /> ATER TABLE DEPT!� ado Pft GEOGRAPHICAL INFORMATION: Coordinates X. y <br /> PERC TEST BUILDING PERMIT LAND USE APPLICATION <br /> TYPE OF—1AK�R-R—. f.:I NEW INSTALLATION REPAIR/ADDITION 1-1 ENGINEER DESIGNED/ALTERNATIVE <br /> ;I REPLACEME It 1l OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION <br /> 1-1 NSTALLATION WILL SERVE: RESIDENCE 11 COMMERCIAL 1-1 OTHER <br /> )HUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: � NUMBER OF EMPLOYEES:- <br /> 0 <br /> MPLOYEES:0 SEPTIC TAI\ltCI TYPE/MF(-..', CAPACITY gal #OF COMPARTMENTS <br /> 1-1 GREASE TRAP TYPE/MFG CAPACITY — gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY*'LINE ft <br /> Q I-IrT STATION SIZE TYPE OF PUMP Q PKGTXPLANT 2 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 2-1 <br /> LEACH LINES I LEACHINGCHAMBERS ft OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL 4z It FOUNDATION <br /> ft PROPERTY LINE ft <br /> FILTER SED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH ft LENGTH —ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 01 SUMPS WIDTH ft LENGTI I ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH 1`1 DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Af,SEEPAGE PITS NUMBER ;?;;, WIDTH 3 ft DEPTH '2,4– -7 ft <br /> DISTANCE To NEAREST WEI-L,2.fg-5> ft FOUNDATION ?6:2 �-b ft PROPERTY LINE ft <br /> 2 <br /> I 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 /> 114INuA48- 121/' NCE RE UIRED FORNSPECTIONS - PLEASE CALL L,?09) 953-769 <br /> SIGNET. TITLE_� DATE <br /> IT <br /> 10 <br /> JOAOU <br /> -ru <br /> AlENTATY. <br /> EFRMNT <br /> Fp <br /> EPARTUENTMEPIVLY <br /> Application kcc ted 3\ Date <br /> ate 7�ldh Area -Y-- <br /> Employee ID <br /> #_—W�— <br /> Final Inspectiony— Date FSPIA0IT-Approved by <br /> Character of Soil to Depth of 3 Pit/ .ImpSoil Character: <br /> COMMENTS <br /> PE SC~ Received Check# Amount Date Permit/ Invoice Permit ID# <br /> Code INFO Ely Remitted Service ReCILJOSt# <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />