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ONSITE W; TEWATER TREATMENT SY� �EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHPARTMENT EET-STOCKTON CA 95202-(209)468- <br /> i NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS., ! EXPIRES 1 YEAR FROM DATE ISSL <br /> JOB ADDRESS v -{'] �i CITY/ZIP S-�-de1L{r�I� <br /> CROSS STREET ff L1 ! r- APN ���' $PARCEL;S+IZfEr L <br /> OWNER NAME CIns' 6��fC�l-�L�- --r PHONE <br /> OWNER ADDRESS (Irr[f l LLM CITYISTATEIZIPtbrUe-�Ls <br /> CONTRACTOR C Cb r rl PHONEL <br /> CONTRACTOR ADDRESS CITYISTATEIZIP ATL'CITDI� . c <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:3?D ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION n REPAIRIADDITION it D ENGINEER DESIGNED/ALTERNATIVE <br /> G REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE E7 COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> t7 SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ 'GREASE TRAP TYPE/MFG tCAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES, D LEACHING CHAMBERS #OF LINES . LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 FILTER BED WIDTH. ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑: .MOUNDED WIDTH ft LENGTH ft DEPTH ft , <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ -SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION. ft PROPERTY LINE ft ` <br /> D DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION. ft PROPERTY LINE ft <br /> U. SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> 1, 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, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMU 24 UR ADVANCE NOTICE REQUIRED FOR INSPECTIO S-PLEASE CALL(209)953-7697 <br /> I! <br /> SIGNED TITLE rr DATE / <br /> r <br /> READ <br /> ICK <br /> Y <br /> ' f <br /> I <br /> b <br /> N <br /> 8 <br /> N r� <br /> DEPARTMENT USE ONL cl! <br /> Application_Accepted�. Date 5 7 (1 Area Employee ID* <br /> Final Inspection Date Z ❑'STP ECIAL ERM{T-Approved by <br /> Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS . % y� �' Z_3 <br /> PE SC Received heckql Amount _. Permit) <br /> Cade INFO By Remitted Date Service Request# Invoice# Permit ID# <br /> �.uo oS SPS - <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10!4!07 c <br />