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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY EWIRONMENTAL HEALTH DEPARTMENT 314 E WEBER AVE-31'PL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE IqSUED <br /> JOB ADDRESS CrIvIZIP <br /> CROSS~MEET ��L'(/J� APN J �� P EL SIZE _ <br /> OWNER NAME O N R jr 7PHONE <br /> J/VJ�I ^N'�tA L PzC...G� <br /> OWNER ADDRESS Q LJ — CITV/STATE/ZIP <br /> CON77UCTOR �_�y� ��i:�e TCn^M — PHONE. <br /> CONTRACTOR ADDRESS t` /yV 1 dg�Tj; t^,;rr C1TY/:STATFJZIP .✓G � <br /> LICENSE --42 ❑C-36 (YrHER NUMBER EXPIRATION DATE� ^ <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INM)RMATIO`l: Coordinates X Y �`v7ya\J, <br /> fO PERC TEST(S) NUMBER LAND USE APPI.ICAT10N# :777 � 1 P <br /> TYPE OF WORK: ❑ N EW INSTALLATION REPAIR/ADDITION ❑ ENGINEER WSIG NED IALTERHATIVE <br /> ❑ RrPLACEMENT I ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: S RESIDENcr. ❑ COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EM OYEPS: 111 <br /> ❑ SEPTIC TANK TYPEIMFO _ CAPACITY gal #OF COMI ARTMENTS <br /> ❑ GREASE TRAP TYPVM FO _ CAPACITY gal #OF COM I ARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION 0 PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR( NCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ _ LENGTH OF LINES Fes_ R <br /> DISTANCE TO NEAREST WELL ft FOUNDATK)N f/ ft PROPERTY LINE � 0 <br /> D FILTER BED WIDTH fl LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEA REST WELL / it FOUNDATION___— _ H PROPERTY L E ft <br /> ❑ MOUNDED WIDrH R LENGTH _tl DEPTH ( ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION _ _ 11 PROPERTY I. E R <br /> ❑ SUMPS WIDTH ft LEN'OTH_ (1 DEPTH ft <br /> DISTANCETONEAREsT WELL _ft FOUNDATION_ _R PROPERTY 1. lF. ft <br /> ❑ DISPOSAL PONDS W1Dn1 ft LENGTH_ ft DEPTH ft <br /> DISTANCE TD NEAREST WELL ft FOUNDATION tl PROPTRTYI. E ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH H <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY I.(NF. ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE.WEPH SAN JOA IN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQU IN COUNTY. <br /> NtIN UM 2,HOUR ADVVAAANNCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE C—A--LL(209)b53-76 <br /> SIGNED �.yr�,�LG _ TITLE <br /> T \ � <br /> �t <br /> RMEIVI <br /> ti <br /> JN <br /> ES <br /> NN UN EN til <br /> DE RTMENT USE O 'LY <br /> ApphcatblE Accepted ByA�wezArcs Empl yce ID#_ G <br /> Final Inspection <br /> By_ Date_ _ / l` _ ❑ SPECIAL PERMII�-Approved by _ J <br /> Character ol'Soil t epth of 3 Ft: PiUSump Soil Character: <br /> COMMENTS., <br /> 7 7/ <br /> PE SC Received Chec Amount ermiU <br /> Code INFO 8 ash Remitted Date Service Invoice# PermitlD# <br /> 42-01-001 <br /> .1102 SITE WASTEWATER PERMIT <br />