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UN51 I t WAS I tWA I tK IREA I MEN I SYS 1 tM h'tKMI I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4653420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS ?-,D-+o3 %J4 ELCad-r R12:,, cmmp LOCdLEFoy- , <br /> CROSS STREET �11"ReIT S�nT yy�j J� (� A�PNC 0101-uL� �It��-4'L PARCELSIZE 2-j.-+ PIC. py <br /> • OWNER NAME /kt(—Jy GE+ LWh/,x\-�••' fL�TEF--�Y'V INYp[ONE%Ir�-J..EO7J- T-7iST F <br /> OWNERADDRESST•a'n� Io40) QOJ ,�fATEVfZI�P <br /> CONTRACTOR LttIE OSS ft- ��JV�MA '�m�""x xL t PHONE 3��-0-s-Q p <br /> CONTRACTORADDREAA40-1- W` OI-TF� si- CITY/STATEZ1-0-0iP 1-0-0iter�1 <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> PERCTEST # ( BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEERDESIGNEDIALTERNATWE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WI LL SERVE: ❑ RESIDENCE ❑ COMMERCW. ❑ OTHER <br /> NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPFJMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPAOITY gal #OFCOMPARTMENTs <br /> DIBTANCETONEAREST: WELL ft FOUNDATION It PROPERTY LINE it <br /> ❑ LIFTSTATION SUZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTHOFLINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATON ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH R <br /> DISTANCE To NEAREST WELLIt FOUNDATION ft PROPERTYUNE It <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WDTH ft DEPTH ft <br /> • DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R <br /> I HERESY CERTIFY THAT]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 /> MINIMMU'�6/.31i�HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED 7 /r \ TITLE "IVSVLT&"-r DATE <br /> P44 <br /> f YI <br /> 1} � <br /> - <br /> tl %7 ,fOgQ `4 <br /> u�ry <br /> IY 77y pON11EN UNC <br /> ;I FpgRT <br /> o .... T <br /> I �tHi®BB® `yj <br /> i <br /> i <br /> e j— <br /> I 'If waax <br /> I I, k ma <br /> i`. <br /> DEPARTMENT SEO Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Data ❑ SPECIALP RMIT-Approvedby <br /> Character of Soil to Depth of 3 FC PMSump Soil Character. <br /> COMMENTS <br /> PESC Reuivetl ee Amount Penralt/ Invoice# Partnit lD# <br /> Code ISC Remitt Date Service Re asst# <br /> 42-0t ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />