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�,QNSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> I JOB ADDRESS�.L �Q �OIx�}{ S�QT. 9� DAIriQ�s€, City/zip_ACAZUea 9-SZXV u+ <br /> 1� m <br /> G i m <br /> CROSSSTREET a�La/Fe lee" ,. APN 913-`/7P—O� PARCEL SIZE �/ ' <br /> OWNER NAME !'! ZL Al UPHONE —41Z41 <br /> OWNER ADDRESS a�"� �} �- CI7YISTATEIZIP f{//tS4,,w,-0 1?n-2--0 <br /> CONTRACTORJI�GC/ _(',1A1jr C/7 /64 _ PHON E_� � I <br /> CONTRACTOR ADDRESS 373 CITYISTATEIZIP f U FZ L OC SCIIf <br /> LICENSE FIC-412 ❑C-36 OTHER+ NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ( R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> El PERC TEST # BUILDING PERMFT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION D REPAIF/AoomoN ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> I INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL a OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES-' <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY_ gal #OFGOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE It <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ PAG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) nt <br /> >D LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft N <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ `� <br /> O FILTER BED WIDTH ft LENGTH h DEPTH ft N <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE - ft CVy <br /> ❑ MOUNDED WIDTH ft LENGTH _@ DEPTH ft <br /> DISTANCE TO NEAREST WELL ,R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH _ ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSALPONDS WIoTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL h FOUNDATION ft PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL �ft FOUNDATION ft 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. moi) <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I <br /> M HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE A�� DATE <br /> 1 <br /> E14 <br /> i <br /> i <br /> VR M-NA Q <br /> S <br /> �­�&Tlkk7MENT USE ONLY <br /> Application kc ce Date r F og' Area Emproy6e ID# fob �4q <br /> Final Ins Ion Date �9�✓ f] SPECIAL PERMIT-Approvetl by <br /> Character DTSDII to Depth of 3 Ft: Pit/Sump SoN Character: <br /> COMMENTSy `C��tSI } � 5 <br /> PE SC Received Amount Dete Permit/Code # Permit ID# <br /> Coda INFO EI ash Remitted Service Re uest# <br /> 42az s�r ,,�, ss -r <br />