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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-769.7 FOR INSPECTIONS_ T EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .7'n' 1r� � '7 CITY'/JZIP/� /1c[.��C.�ro-�, L7�i <br /> CROSS STREET j __-_APN D 0/—/310- 19{ PARCEL SIZE 412_ <br /> OWNER NAME JCl.y_ JL.-L'JJfNC/"' PHONE <br /> OWNER ADDRESS / CITYISTATE/ZIP Y" <br /> CONTRACTOR ri" /ray! f ✓ �ic�."�- PHONE 3Z9 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ;KC-42 [1C-36 OTHER NUMBER 61S5�VVS- EXPIRATION DATE 07-3.1-10- <br /> WATER <br /> //ZWATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK NEW INSTALLATION REPAIR/ADDITION .-. ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM _l DESTRUCTION <br /> INSTALLATION WILL SERVE: r] RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG �t✓L CAPACITY 16:«J gal #OF COMPARTMENTS <br /> i <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS _ <br /> DISTANCE TO NEAREST: WELL /.AC" ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES .1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R <br /> FILTER BED WIDTH r ft LENGTH_ I-Z' ft OEPTH�Zr/ ft <br /> DISTANCE TO NEAREST WELL I 1?,r�;' ft FOUNDATION l), ft PROPERTY LINE SG t ft <br /> ❑ MOUNDED WIDTH_it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ___ft LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH 11 LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE if <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 /> MINIMUM 24 HOUR ADVANCE NOTICE RE UIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED - TITLE /J�.%:%s>F=�-� DATE 1 id'J11 <br /> -------------- <br /> I <br /> ' L�SSuy <br /> — . J <br /> L. FA LLLL <br /> - _ PA' ENT SE LY <br /> Application Accept4d,,710 <br /> Date <br /> Final Inspection By -I.- Area Employee ID# <br /> ,'-' J Date II SPECIAL PERMITApprovedDy <br /> / <br /> Character Of Soil to D th of 3 Ft: r PitlSump Soil Character: ---- <br /> COMMENTS <br /> PE- - SC Received ChgollI Amount Date Permit/ Invoice# Permit 10# <br /> Code INFO B _ � ath� _Remitted Service Request# <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 9121/10 <br />