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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)465.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS , EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS i_"���gnu,_1_�e_QcZ CITY/ZIP4_n./` y <br /> CROSS STREET Dnsirc APN 2` •— O �0 a'" PARCEL SIZE 7-S�R� o <br /> '+s °z <br /> OWNERNAME O W6e yPHONE.. w <br /> OWNER ADDRESS kTY/STATEI P <br /> CONTRACTOR PHONE :3L-9-SVZ7-- ••' . <br /> CONTRACTOR ADDRESS //�/r/�- CITY/STATEIZIP <br /> LICENSE C}CA2 ❑C-36 OTHER r :NUMBER 6G 12 EXPIRATioN DATE 07- <br /> WATER <br /> 77WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# Q kO I Sr7O LAND USE APPLICATION# <br /> TYPE OF WORK: Ak NEW INSTALLATION L7 REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE - <br /> 0 REPLACEMENT ,d 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 49 COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: LS NUMBER OF BEDROOMS: n NUMBER OF EMPLOYEES: <br /> (� SEPTIC TANK TYPE/MFG CAPACITY &�j/Ogal #OF COMPARTMENTS <br /> 11 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS fl <br /> DISTANCE TO NEAREST: WELL I-7W it FOUNDATION G I It PROPERTY LINE • 40' ft {' <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> a LEACH LINES .LEACHING CHAMBERS �f' #OF LINES '7 LENGTH OF LINES ��/ R (1�j <br /> DISTANCE TO NEAREST WELL I�36� it FOUNDATION �b� It PROPERTY LINE ykS ft Qi <br /> O FILTERSED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 1 <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ' <br /> ❑ DISPOSALPONDS WIDTH it LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft j <br /> 13 SEEPAGE PITS NUMBER WIDTH It DEPTH it <br /> . <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> $IGNEO TITLE�p «tY,6.c DATE •/��Io F' <br /> HEU <br /> oa .Y <br /> T D P F1<T <br /> ( <br /> 5 <br /> I <br /> s <br /> --,- - -DEPARTMENT.-U <br /> Application Accepted B( Data 0 X Area Employee[D# 479 <br /> Final Inspection Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil pth of Ft: <br /> Pit/Sump Soil Character. <br /> COMMENTS <br /> A-)r— 330yc_c._IE.Qu.y c-� 1-t-"b�tG cjC-t rc-r 5.�7 A•-c.(�'S <br /> PE SC Received Amount PermiU <br /> Cade INFO Cash Remitted Date Service Request# # Pennk <br /> 8 .Soa. 0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> * 1014107 <br />