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ONSITE WASTEWATER TRTMI` SYSTEM PERMIT <br /> SAN JOAQL EN COU--;'.ENVIRONMENTAL HEALTH DEPARTIIIIENT S.E MAIN STREET•STOCKTON CA 95202-(209)468,UW <br /> NON-REFUNDABLE PERMR CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRsss I s f� 1 4�.!1' ;i }y . _ C.T a p_L} T, '9 5'2 L(0_ � <br /> I <br /> CROSSSTREET l r 'v",, \{L\ APN L: .!T+.i"°`4� � PARCELSU:E <br /> e <br /> tt 9 tJ a <br /> OWNER NAME�I:+'�f� �{_?(3�(3`�1!Y _ � PHONE Syn9 <br /> OWNER ADDRESSGITY/STATEl7Jp <br /> CONTRACTOR C.,4 LIF...'.0({�'� (a � - � -PHONE ' <br /> CONTRACTOR ADDRESS .� GI CITYISTATEIZIP - ! L t ,� I• r j <br /> LICENSE 4C-42 QC•36 OTHER NUMBER ExPIRATmN DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #. -( BUILDING PERMIT# LAND USE APPLICATION#_?A <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAPJADOITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> O SEPTIC TANK TYPE/MFG CAPACITY 901 #OF COMPARTMENTS <br /> Q GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFTSTATION SIZE TYPE OF PUMP O PKO TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM} j <br /> I� <br /> d LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDA'RON ft PROPERTY LINE fl <br /> © FILTER BED /Mum ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> 13 MOUNDED WIDTH ft LENGTH ft DEPTH ft I` <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft .� <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH it f <br /> DISTANCE TO NEAREST WELL ft FOUNDATION - R PROPERTY LINE ft 1) <br /> © DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE - ft1 <br /> 0 SEEPAGE PIT'S NUMBER WIDTH ft DEATH It <br /> - DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 'ttom <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE MTN SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MJN��IA� 14 HQUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209 953-7697 <br /> SIGNED ����.�_ _ TITLE.th-'_.L ,! '.d, DATE l �L� <br /> L <br /> L' <br /> k <br /> t <br /> tTZ <br /> I <br /> DEPARTMENT <br /> / U•SEpNLY <br /> Sm <br /> Application Acepted By OatfU_ <br /> Area <br /> Final Inspection By Date ❑ SPECIAL PERifII� <br /> Character of Soil to Depth of 3 Ft: PWSump Soil ChaTaater: <br /> COMMENTS <br /> PE SC Received Check#!- Amount Dat Perfnw Invoice# PermI11D# <br /> Code INFO B Clash Remitted Service Re nest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> S/2S*9 <br />