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-�` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT- CA L 209 953-76 7 FOR INSPECTIONS `'EXPIRES 1 YEAR FROM DATE ISSUED <br /> I JOB ADDRESS (/!J CITY/ZIP N <br /> L �/ )p• 2 H <br /> CROSSSTREET e� /• APN ✓ /7 U�pC0 '7 PARCEL SIZE�,l�C/�-ti D <br /> + OWNERNAME ''//I NO SeH-tit r/ Q •/ PPH�ONEI�{�'7�����^�7/� <br /> OWNER ADDRESS iQ9R 45 e�(, //`90 P_�t A � CITYISTATE/ZIP //2q`J.}��f N <br /> CONTRACTOR "' PHONE <br /> CONTRACTOR ADDRESS CITY/STATFJZIP <br /> Y LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O LAND USE APPLICATION# <br /> TYPE OF WORK: 7A NEW INSTALLATION ❑ REPAIR/ADDrriON_ ❑ ENGINF,ERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT I ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ffRESIDENCE. , ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> SEPTIC TANK .TYPFJMFG I Tf CAPACITY OO gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG I. CAPACIT gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL + R FOUNDATION ft 'PROPERTY LINE r R <br /> ❑ LIFT STATION SIZE (TYPE OF.PUMP - ❑ SAND OIL SEPARATOR(ENCLOSEVIJYSTAEM) <br /> W <br /> LEACH LINES ❑ LEACHING CHAMBERS .. #OF- _S - LENGTH OF LINES �Q ,ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATI N. R PROPERTY LI E R <br /> I` ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R c) <br /> 1 ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft R <br /> r DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R O <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH' ft DEPTH R <br /> DISTANCE TO NEAREST WELL - ..ft FOUNDATION ft PROPERTY LINE R <br /> I ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH - R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADV NCE NOTI RE UI ED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ct�y1/��S 1 O -��.A � TITLE CtJAJe-/L 07 DATE F-- 7 <br /> . ..,_-.r'.-•,.-�^-^ ---v-s-..-. nom-._ — - --.:.- - .�- ... - .. _. . <br /> NEW SEPTIC <br /> SYSTEM <br /> leo 5 <br /> �, <br /> RE 139' +/- <br /> 1 RE§IDEN <br /> o NEW WELL, <br /> ovt14 GOUT <br /> 30p, <br /> I SA ENV1HONM� <br /> PIL <br /> HATH pEPA I I I o <br /> I + <br /> `C) A 156' +/- <br /> Z � M <br /> I <br /> :--DEPARTFiEN -- - - <br /> Application Accepted By te, (o C• 07 Area Employce ID# SFU t-FS .S 9 <br /> Final Inspection By ate 'll'� +_. ❑ SPECIAL PERMIT;Approved by / <br /> Character of Soil to Dep of 3 Ft. PI ump Soil Character: <br /> COM NT p F <br /> I <br /> I PE Sc Received Cheek# Amount Permit/ ' <br /> Code INFO - By- ash- _ Remitted Date .Service Re uest# Invoice# Permit ID# <br /> 42-11 a 00-7 0q1M5IQ <br /> 42-02-001 - - - `�, ONSITE WASTEWATER PERMIT <br /> 12/21-12003 <br />