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UN51 I t WAS-I EWATER 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 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (9'-1 z-S E. AouGltE2TV R-A. ,( CITYmP fkUL� mPO <br /> CROSSSTREET KENNLF//C,K ' APN 61l- 14a- �T PARCEL SME FL @y <br /> • OWNER NAME AANDy P-c&cT PHONE - 0-+C)/ G <br /> OWNER ADDRESS I • o• p30 x /1&1 <br /> 1&G1^�A �.p CMISTATEMP GLOD•L[1�,CA '?VZ-41 <br /> CONTRACTOR 14%IC OAIC &CDEA/\,1XONNTEA/TAL PHONE 3 C ct- O/ lJ <br /> - �tG <br /> CONTRACTORADDRESS TcT W . D/-[F ST• cm/STATEZP L6Dl ATF ff-2-4L7 .i <br /> LICENSE QC42 ❑C36 OTHER NUMBER EKPIRATICN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrtlinMS5 X Y <br /> -Pr PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 0 NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNEDIALTERNAME <br /> 0 REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCETONEARMT: WELL It FOUNDATION ft PROPERTYLINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP D PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTH OFLINES ft <br /> DISTANCe TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYUNE ft <br /> ❑ MOUNDED MOTH It LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIM11 ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIM ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> • DIBTANCETONEAReBT WELLA FOUNDATION ft PROPERTY LINE It <br /> I HEREBY CERTFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BECOME IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 3.lbuR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 •'T� <br /> SIGNED TITLE Ce Nsvw--A r DATE y <br /> g i15 <br /> 6 JN �C <br /> �, ITdb.. :.dDw,tr•h�c w�-11 �; <br /> awcecm'""aua .,•�,. <br /> r.. <br /> DEPARTME T O L �( �(]�/ <br /> Application Accepted By Gam � Area 1 1 Un --- <br /> Final <br /> 7 Employee ID#__� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-APProveo by <br /> Character of Soil to Depth of 3 Ft: PIUSump Soil Character. <br /> COMMENTS - WZAA/L4. /htiLM•G\ Cw,`� - Gj^� �5.t1 �tf �n <br /> • PESC Receiv Amount permit <br /> tle INFO sh RemittM Service Request# Invoice# Permit IDB <br /> a3 • c✓ tl fl 1"45 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />