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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT y CALL(2091953-7697 FOR INSPECTIONS ExPIRES 1 XEAR FROM DATE ISSUED <br /> JOB ADDRESS y f � �1 CITYZP �l�I/ �Cs23b I yy <br /> CROSS STREET /lfS/C../ APN 0[2 --d 4O^--513 PARCEL SIZE <br /> OWNER-NAME l7'� ^� / B� PHONE <br /> OWNERADDRESS Y o 6o K O 2— CRY/STATEZP /' C��n✓�/QrVv/y��1`- �(J O <br /> CONTRACTOR O PHONE <br /> CONTRACTOR <br /> ///ADDREr�S �l S �- �� ��'�.'+.'y �r�- rr//X/y�GE�CITY(STATEIZJP �r.+C.-/�N(��[/ /S+�Z <br /> LICENSE g�y-42 4iC-36 OTHER, W !✓ NUMBER-,f'=- XPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # —� BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION r IT ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION D4D INSTALLATION WILL WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LONG UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG �� CAPACITY 1 o gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) t <br /> LEACH LINES "' LEACHING CHAMBERS #OF LINES / LENGTH OF LINES /"� J ft <br /> DISTANCE TO NEAREST WELL 0 wZ R FOUNDATION �O!+� ft PROPERTY LINE �~ R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ' <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPT ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH fl DEPT ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH , ft DEPTH L� �+ _ R <br /> DISTANCE To EAREST WELL 1 FOUNDATION �d�f' ft PROPERTY LINE J L R <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 /> MINLWM 24 HOU -ADVAMCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNE TITLE a DATE <br /> _ 1 <br /> rMylvit Ilk <br /> I IN 12 'Mil <br /> 1 <br /> I _ <br /> aQ Iry ou rr <br /> E <br /> ILr �� I N L HD(PA,TENI <br /> M <br /> I <br /> I <br /> i <br /> DEPART LENT U SE ONLY <br /> Application e <br /> -=2 7�'=��q`rea — ':•f±rriployee.lb#��54� -G1� <br /> i� / Y <br /> i Final Inspection �- Date ❑ SPECIAL PERMIT-Approved by <br /> Character of SoU to D th of 3 Ft: P t/Sump Soil Character: <br /> COMMENTS L-0 ©4d ?c+o `4-r OC-0 L49S4 <br /> LJ s TTS_ sus r-e <br /> IPA" <br /> co-rsPt.Lr -_ wtLc ",b Tb Ewsr1­� <br /> ( PE SC Received heck# Amount Parra Invoice# Permit ID# <br /> Code INFO B s Remitted Date Service Re ueat# <br /> �i2to R GL7 /3 ]s�z S�00�0Z- -- <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 9121110 - <br />