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/03a <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 690 E MAIN STREET-STOCKTON CA 95202-(209)468Ja26 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE IssU&D <br /> JOB ADDRESS -TG O/J/�GacG /tri^yG. CITYM ton /J L <br /> CROSS STREET /O/YI1G fl i i✓IC D!/•✓ APN PARCEL SIZE <br /> OWNER NAME ��ah4T7<D/1� Qt✓vC I,nm e,-;,- ti ;i PHONE ° <br /> OWNER ADDELSS R 7]� 1:5-4-m /SOV/iyJ/er/ SL%/c e^LOO CITY/STATFJZIP S4 e ri m-A7.,* C.4 <br /> CONTRACTOR (j a IC&A Cons ��.n fi_ 7^c PHONE 9/G 2 7 9-/-x V3 <br /> �. CONTRACTOR ADDR{:SS 3/6 O Go%/Ua 1/t✓Or/rc A 08VO CITY/STATElZIP /t"ri/1!l0 4forc�i✓G- 95 7114 <br /> LICENSE ❑ C-42 ❑ C-36 OTHER n-,#A Z C-S7 NUMBER 7//0—TV EXPIRATION DATE /.2-3/•O T <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> O PERC TEST M BUTLDTNG PERMI•F k LAND USE APPLICATION IG <br /> TYPE OF WORK: O Naw INSTALLATION RE►AIR/ADDTLIOIIN�r ENGINEERDEAGNED/ALTERNATIVE <br /> 0 REPLACEMENT PC DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE O COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> i SEPTIC TANK TVPF/MFG� _— CAPACITY yl MOFCOMPARTMENTS <br /> ❑ GREASETRAP IYPF/MFG CAPAcrnY Eal MOFCOMPARTMEMTS <br /> DISTANCE TO NEARRS ri WELL ft FOUNDATION _ R PROPERTYLNE ft <br /> .� ❑ LIFTSTATION SLEe TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS M OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST W&J. ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTERBED WIDTH R LENGTH _ft DEPTH It <br /> DISTANCE To NEAREST WELL_ ft FOUNDATION_ ft PROPERTY LINE R <br /> ❑ MOUNDED WIMR ft LENGTH R DfiP[H ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS VAVM ft LENGTH_ ft DEPT ft <br /> DISTANCE To NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTR ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft MO►ERTY LINE R <br /> ❑ SEEPAGE PITS NUMan WmTx ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION @ PROPERTY LINE R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 2 LR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED/ TITLFt�!)/P1PissvGsT/y4v• IPME+ <br /> DATE x;[ <br /> $ Pi O O IN O <br /> Fir <br /> .n. <br /> EPARTMENT)ISf9A <br /> Application Accepted - i�"t Dau J-1 Area Employee IDM '117 <br /> Final luspeetion Ry Dale 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to h ora Ft: Pit/SRmp Sell Character: <br /> COMMENTS 466 6 T�ks -k'a-" A -L S«t tit-F�Ct;.i�• I1�T�_��ct< sy�f''`a nur7t�/Yrr2.b dE <br /> 5xi <br /> PE SC Received Cheew Amount Permit/ <br /> Code LNPO B Cash RemiRed Date Servi ert M Invoice M Permit IDI{ <br />