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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS LEXPIRES 7 YEAR <br /> FROM DATE ISSUED . <br /> JOB ADDRESS 3(R 01 N • NANI O U` a.� Clwmp STD C--'1-QrQ <br /> C <br /> CROSS STREET IZ1>A W AN/ APN IVIS Z l O�O* �.97 TTI. a> <br /> .y. PARCELSRE b <br /> • OWNER NAME FFD S�PPL_y W1't'1'Te, CV4? PHONE 'Tiro -SSI- y3S-(o <br /> OWNER ADDRESS I(09 Cy1�EV I'-•C.IL IF rV . CIT//STATE/LA-OL <br /> P SeVILL GA 'MR&I <br /> CONTRACTOR LIVE DAY_ C—F-0eNytRe>✓IMIE& TAL PHONE 3(R9- O;-'S <br /> CONTRACTOR ADDRESS -I W 0„F� :, CITY/STATE/ZIP LODE CA 9S'X'fO <br /> LICENSE QC-42 QC46 OTHER NUMBER EKPIRATIONDATE <br /> WATER TABLE DEPTH: R GEOGRAPHMAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMITA` LAND USE APPLICATION A` <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAINAONTION ❑ ENGINEER DESIGNEDIALTERNATNE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESWENCE ❑ COMMERCIAL 0 OTHER <br /> NUMBER OF LNINO UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY Bel #OF COMPMTMENT$ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY BSI #OFCOMGARTMENTS <br /> DISTANCE To NEAREST: WELL�_ fl FOUNDATION fl PROPERTY LINE R <br /> CILIFT STATION SIZETYPE OF PUMP; O PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTHOFUNEs ft <br /> DISTANCE TO NEAREST WELL - - It FOUNDATION ft PROPERTY LINE A <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION fl PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH fl DEPTH It <br /> DISTANCE TO NEAREST WELL ! 1 ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ftN KITH fl DEPTH <br /> DISTANCE TO NEAREST WELL ft <br /> fl FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMSER WIDTH ft DEPTH # <br /> • DISTANCE TO NEAREST WELLY___fl FOUNDATION ft PROPERTYLINE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATICN PND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUh]z4➢IOUR ADVANCE NO--IC::REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /C/le <br /> TITLE coNfdl.'TRNT DATE (11 -11 - 16 <br /> Age <br /> Uj <br /> i ) `rYCL <br /> aLU <br /> LU <br /> a UJ <br /> 77 <br /> C \ <br /> _ a . _ <br /> C PARTMENI SE LY� /'") <br /> Application Accepted -Date Area Employee IDNAS / <br /> Final Inspection By _ Date 0 SPECIAL PE MIT-Approved by <br /> Charactero/Soil to Depth Of 3 Ft: P1VSump Soil Character: <br /> COMMENTS <br /> • <br /> PE SC Received Check#/ Amanna Permal <br /> Code INFO B ash Remittee Dat° Serviee Request# Invoice# Permit lD# <br /> Z111115N&KOD7 2i <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />