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I >�� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ' <br /> 4� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLE PERMIT <br /> CALL f2Q9)953-7697 FOR IN <br /> FROSS <br /> y- �j5 tf/- /�. EXPIRES 1 YEAR FROM DATE ISSUED <br /> /40 CITY/ZIP L-od� 952¢y, <br /> I N / <br /> APN —�ZS IIO—¢ 1 9 PARCEL S12E <br /> /.�Dl .L DP1PHONE �79-5373SS O• g�X 29G� <br /> CONTRACTOR ry ` �U f��7/1./ CITY/STATE/ZIP J' IWAV31-nf/V/(4, // <br /> � 0 <br /> Z7 <br /> PHONE � J .�/ <br /> CONTRACTOR ADDRESS _ �'D ^ / ` 91 s—�/ <br /> Clry/STA7E/ZIP— '�(/D4 / <br /> / <br /> LICENSE 'C-42 1-_C-36 OTHER NUMBER <br /> ( L EXPIRATION DATE <br /> I` WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# Y <br /> TYPE OF WORK: 71 NEW INSTALLATION <br /> ❑ REPAIRlADDITON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> -� REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM G DESTRUCTION r <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 'E COMMERCIAL ❑ OTHER <br /> NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: f <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft , <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE —it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH tt <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft rOUNDATION ft PROPERTY LINE h <br /> I HEREBY CERTIFY THAT 1 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> /I I <br /> -...rte ter• � r�� -=�./r ,rl i; I �J 1 <br /> _ �bT� 1 r <br /> „ I <br /> vww <br /> 60Ip I I <br /> (,I <br /> ui�Mr I <br /> Ise,* 41 <br /> { ' i SA JO CULO <br /> 1 1•--r�� 1 I'! rr I ON ENT <br /> Vi I i I i H LTH DEP <br /> Application Accept Date Area Employee ID# <br /> Final Inspection B t'. / Date L SPECIAL PERMIT-Approved by <br /> Character Of Soil to epth of 3 Ft: PK/Sump Soil Character: <br /> COMMENTS .s5 / y �< %f��?1� /� <br /> /' J� ?—?—=?—?—= (-�5��/j�"j/,�jj, <br /> 3=�Gty/3/.���✓/!J!,i� fx�= ���3Ls�/1?i l/i J>)' = l o� �v�/.lo/Nr_J/n7� �/ <br /> PE Sc Received hec Amount Permit/ <br /> Code INFO 8 miffed Date Service Re nest# Invoice# Permit ID# <br /> uz �� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9121110 <br />