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ONSITE WASTEWATER 1 KLA I MI=N I ala I CIYI rcpcLm I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NOWREFUNDABLEEP/,ERMIT C CALL 209)953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOBADDRESS 1-OOoI 's• LGN rK AN I n% CITYIZIP /�Jf,,�c- �� - <br /> CROSS STREET JAMES Z/NNr cYJ APN 2�3- 33a- 33 PARCEL SME <br /> 7-1140 <br /> OWNERNAME J A MES C-6-WGI_DE� 45- <br /> PHONE �'�^3- /T3-11(v <br /> • `• 10"'I" Sr. CITY/STATEZP TF'IK LT �SJ J{y <br /> OWNER ADDRESS IOJ /� d w b <br /> CONTRACTOR L'I VE OA/�Z-&eoWVu"r-JF'>7�TRL- PHONE 3yl-o3}r <br /> -T M' LO-P I CA r4! 7-40 <br /> CONTRACTOR ADDRESS ��n�-�t w• O`��' S/ CT'/STATEZP <br /> LICENSE QC-42 QC36 OTHER NUMBER EXPIRATION DATE <br /> WATERTABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> )K PERC TEST # I BUILDINGPERMIT# LAND USEAPPLICATION9 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPARdA.U'-ION ❑ ENGINEER DESIGNED/ALTERNATNE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OFLMNG UNITS: NUMBER OFBWROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY 981 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY 981 *OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION it PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP, 0 PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES D LEACHING CHAMBERS #OFUNES LENGTHOF LINES It <br /> DISTANCETCNEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH R LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It <br /> C3MOUNDED WIDTH R LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL I r It FOUNDATION R PROPERTY LINE It <br /> Cl SUMPS WIDTH It LENGTH It DEPTH It <br /> DISTANCETONEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSALPONDS WIDTH R LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELLit FOUNDATION R PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft <br /> • DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTYLINE it <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THI LnAWS AND RULES AND REOMWI L SEDONSS OF SANIN ACCON COUNTY. SAN JOAQUIN COUNTY ORDINANCES, <br /> STA,MI•NIMU"HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ,(/' ��/C/J TITLE CONSVtTFY wr DATE <br /> wem• w ' tI •� .e. w'I <br /> t romGNATDI ROWND£R• <br /> I` Q 6 <br /> VYN C <br /> AgTMFN+T <br /> ; <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date )i 1 f!�(L� Area��--�- —� Employee <br /> Final Inspection By Date -TT'T ___ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft PR/Sump Soil Character. <br /> COMMENTS <br /> • PE SC Received h Amount' Date Permit/ Invoice# Permit lD# <br /> Code INFO Cazh RemiUeO' IS rvice'R ueat# <br /> 42,01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />