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ONSITE WASTEWATEEATMENT SYSTEM PERMIT <br /> dOUNTY ENVIRONMENTAL HEALTH DEPARTMENT _ 600 E MAIN STREET-STOCKTON CA 95202468-3420 <br /> lieNDABLE PERMIT ` CALL 249 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> y� `�7 L~ t/1(-fib { CRYIZIP 0 LA 4- -)C,2-L <br /> APNPARCEL SIZE <br /> STREET �\r C•�^F I�� r7 - <br /> ,/NAME 7`� PHONE <br /> 1 <br /> /ERADDRESS E7A('* '- A'b A(6aV L _ CITYISTATE)ZIP n <br /> )ONTRACTOR C..?1�S'T 3n[a•C 1'W�- \'V+� `PHONE <br /> LCONTRACTORADIRESI 1�\V E �p t•'�3CITYISTATEIZIPT NSE OC-42 Q C•36 OTHER NUMBER tJ ExPIRATION DATE 2SNO <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# f�1 <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION G ENGINEER DESIGNED- <br /> 11 <br /> ESIGNED(❑ REPLACEMENT ❑ DESTRUCTION -- <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> I NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I] SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> UK GREASE TRAP TYPEIMFG 17,00 SW Crc�rl _ CAPACITY •L—�A gal #OFCOMPARTMENTS �- <br /> DISTANCE TO NEAREST: WELL 1�� ft FOUNDAThON 5 ft PROPERTYLINE ICA=) ft <br /> • LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> © LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I] MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST - WELL ft FOUNDATION ft PROPLRTY LINE ft <br /> L3 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, <br /> I STATE LA D RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SI TITLE C fC5 LES DATE J <br /> 1 <br /> -14 <br /> 1 <br /> E <br /> I A90 <br /> a uI D <br /> e <br /> DEPARTMENT EON <br /> Applicati Date Area EmployeelD# �9 <br /> Final Ins �Accepted <br /> Date Q SPECIAL PERMIT-Approved 6y <br /> Character of Soil t Dept f 3 Ft: PiVSump Soil Character: <br /> COMMENTS <br /> PE SC Received Check Amount Date Permit/ <br /> Code INFO B ash Remitted Service Re uest# Invoice# P It I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM P MIT <br />