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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3M11 FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT /J CALL(209)953-7697 FOR 1%SPECTIOSS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS � , L// �- �(� CITY/(ZIIP�f'-- �/�� /`�f (/'S�( D <br /> CROSSSTREET � ) `�j7 yr//�Y!`/+� I l AIN 107 - O Q'V I7 PARC EL SIZE l,Ivj�v' bQ o <br /> OWNER NAME S/C_i l' lc 2 c"Ie2 r7E N ft y PHONE <br /> i <br /> OWNER ADDRESS J CITYISTATE/ZIP C C%`}'�'S27 '•�C�/, <br /> CONTRACTOR �i � yy/� 7[�//7- ���. PHONE <br /> CONTRACTOR ADDRESS CITY/STATE.'ZIP rt2� <br /> LICENSE )aC42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICALINPORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICA TION# `y <br /> TYPE OF WORK: ;L NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION _ (� <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER _ <br /> NUMBER OF LIVING UNITS: 1n L I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 1 ` V CAPACITY ZG� gal N OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS !rl <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES S LENGTH OF LINES it o ft <br /> DISTANCE TO NEAREST WELL ���/��nl FOUNDATION It PROPERTY LINE it <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH A DEPTH R <br /> o, DISTANCE TO NEAREST WELL R FOUNDATION_R PROPERTY LINE Ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCEToNEAREST WELL ft FOUNDATION ft PROPERTY LINE H <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH Il <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE H <br /> s , <br /> SEEPAGE PITS WIDTH �ft LENGTH It DEPTH <br /> 7 /�l <br /> DISTANCE TO NEAREST WELL �r0'f' ft FOUNDATION�LL�" It PROPERTY LINE ft <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 /> M <br /> L. HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL I-'1191953-7697 <br /> SIGNE i i TITLE � � DATE S <br /> f <br /> l <br /> i <br /> e <br /> f <br /> 1 <br /> HE LTH SER 9CE <br /> El\IR n:M <br /> -AIX t <br /> DE/P,KRTM^�ENT US NLV <br /> Application Accepted B .L„ Date ] 3` ,3 Area f Employee ID#� <br /> Final inspection B Date /aa_egSy - 13 SPECIAL PERMIT-Approved by - <br /> Character of Soil to De of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS (bt/b SH 01 —f 4 <br /> l zZe c e&t-Soc� <br /> PESC Received Check#! Amount Dale Permit/ Invoice# Permit ID# <br /> Code INFO B as Remitted Service Re uest# <br /> •}f��i� 7L�q/ W311b3 S OC 33 2q <br /> w-C GaT AW7 Z7�/CTi�- L�/`l�/�- 51e)Mt ���� <br /> G, rO/•43111YJ/�t/�S�G S4P/1l(=�5��/J`� (iL-� .,ygS"i`EWA R 11T- <br /> 4� u14b�/ `1"Kf9n.S/ Tdcs.J7.1c7 ,�L�Ritt.IBUJG acvnLl7�o.l ups/ 7z 4�/3s-/ <br />