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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3020 <br /> NON-REFUNDABLE PERMIT _CALL(209).953 7597 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> or <br /> JOB ADDRESS � - Li� �„ _ ___ __ CnY21P--- Yrs" i� _.__ <br /> {{ ) : GG 1. <br /> CROSS STREET FY`t E+' f'Ll APN _ 3t� �$k PARCEL SIZE <br /> OYMER NAME .'€_ _ __ PHONE f Y <br /> t __ <br /> OWNER ADDRESS <br /> CONTRACTOR.— __ PHONE f ,r <br /> t <br /> CONTRACTOR ACIDNESS CMISTATE21F t `� <br /> LICENSE 1042 C-3l^6� OTHER _. NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: V _ it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> rr a PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# m( <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> r <br /> NUMBEROFLNINGUNin: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY _ gal ttoFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS q <br /> DISTANCE TO NEAREST: WELL It FOUNDATION it PROPERTVLME ft ` <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PRO TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) i <br /> O LEACH LINES LEACHING CHAMBERS OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL fl FOUNDATION it PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE H <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTn it <br /> DISTANCE TO NEAREST WELL _it FOUNDATIONR PROPERTY LINE ft <br /> ❑ SUMPS WIOTN_ _ _ft LENGTH_ _ _ it DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY I INE It <br /> ❑ DISPOSALPONDS WIOTH ft LENGTH R DEPTHIt <br /> DISTANCE TO NEAREST WELL _ fl FOUNDATION _.._ it PROPERTY LINE—ft -• <br /> ❑ SEEPAGE PITS NUMBER WIDTH_---- .. It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDA,ON h PROPERTY LINE ft _ <br /> I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> --}}_ <br /> MIN <br /> M ]I HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-RLEA$jE CALL(20)953-7697 <br /> SIGNED .� 1 TITLE DATE <br /> f <br /> ------------- <br /> r , <br /> f ' <br /> _ _ 1 <br /> 8 <br /> 4 U <br /> Tin WNW <br /> E <br /> -" DEPARTMENT USE/ONLY <br /> Application Accepted By — _ -- Date -! ' ' - Area Employee ID# <br /> Final inspection By__ Date Ll SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:__._._ Pit/Sump Soil Character: <br /> COMMENTS <br /> PE .SC Reca vetl Check#1_- Amount Permit/ — <br /> Data Invoice# Permit lD# <br /> COM INFO By C h R tted Sell.Request# <br /> I:nl t <br /> @-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10,407 <br />