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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTM1IENT 600 E MAIN STREET-STDCKTON CA 95202-(109)466-3420 <br /> NON-REFUNDABLE PERMIT GALE 209)953-7697 FOR INSPECTIONS EXPIRES/17 YEAR FROM DATE ISSUED <br /> JOB ADDRESS sYl7q ' 1'L. CITY/Zip 71r,rA-i0 v <br /> CROSS STREET SA N 094 APN 001- 1406-- !9'7 PARCELSII.E <br /> OWNER NAME 7 <br /> Lcllk- n <br /> PHONE <br /> OWNER ADDRESS <br /> CITYISTAT19APP/� <br /> CONTRACTOR C PHONE _ J 0�T/,^ <br /> CONTRACTOR ADDRESS CITYISTATE/Z1P <br /> LICENSE fif C-42 ❑ C-36 OTHER__ NLh1BER �S7 D>Ov - RAT-Ox DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates <br /> ❑ PERC TEST N BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NBW INSTAI,I.AifONRLPAiR/ADDITIO 0 ENGINERR DESIGNED/ALTERNATIVE <br /> 4 REPLACEMENT DESTRUCTION G <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL O OTHER <br /> NUMBER OF LIVING UNITS:_ I NUMBYR OF BEDROOMS: NUMB4R OF EMPLOYEES: <br /> SEPTIC TANK TYPFJMFGL CAPACITY IOC? <br /> get 1F OF COMPARTMENTS <br /> O GREASE TRAP Ty pE/MFG CAPACITY gal #OF COMPARTMENTS <br /> f i I <br /> DrST.ANCE TO NEAREST: WELL ft FOLINUAT1ph'�ZQ�_.. _ fl PROPERTY LPl6 34F jl <br /> O LIFT STATION SIZE TYPE OF PUMP E3 PKG Tx PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES I'd LEACHING CHAMBERS110E LINES �I <br /> p �_ LENGTH OF LIItFS f OO R <br /> Di STANCE TO NEAREST WELL,d-C< -iu- ft FOUNDATIONft PROPERTY LINE 3D �ft <br /> Cl FILTER BED WmTD ft LENGTH ft DEPTH A <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> 0 MOUNDED WEYM ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WEIR. ft FOUNDATION_ ft PROPERTY LINE ft <br /> O sumpsWIDTH fl LENGTH_ _ ft DEPTH ft n <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft <br /> Cl DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ' ft FOUNDATION n PROPERTY LINE <br /> D SEEPAGE PITS Numsim WIDTH ft DEPTH fl C <br /> DISTANCE TO NEAREST WELL ft FJUNDATTON R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TtiF WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY d <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANC 01-ICK REQUIRED FOR IN!9PECTI0NS-PLEASE CALL(209)453-7697 // <br /> SIGNED TITLE_ CJl DATE // -714 <br /> J <br /> I IL <br /> ' 0P, I- <br /> I <br /> Af � <br /> 7 <br /> N L J fY <br /> NV HO M Pl <br /> DEPARTMENT LY <br /> Application Accepted By Date 'SEf Area E io ee III <br /> Final Inspection T14 Y <br /> pection Ny Osee Q SPECIAL PER-MIT-Approved by <br /> Chsratter of Soli to th of 3 Ft: Pit/Sump Sall Character-, <br /> COMMENTS Cf-4{7 [ F 4Z-c o �7 <br /> 41 <br /> a2un A< O k <br /> PE SC Received C Aalaunt Permit)Code INFO Css Remitted Dao Service R u.t# luvaiu It ermie LDN <br /> z 09 to <br /> Q S d I <br />