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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT EXPIRES 1 YEAR FROM DATE ISSUED <br /> NON-REFUNDABLE <br /> c PQEGR�MIT /� QCALL 2O9 953-7697 FOR INSPECTIONS STOGK�� <br /> JOB ADDRESS ,2 I 1 �jIE �I P1`��0 `�• CITY/ZIP �y <br /> CROSS STREET S�Z- 12 , ��1N Acl� APN _ I - 7—D 'PALRCEL SIZE �'�7r 7�' <br /> �UZ�I�I nJI�,AD PHONE 4�ID- ��JJ <br /> OWNER NAME p <br /> (y S R 9 �PPI AN o 1-� CITY/STATE/ZIP 5'�(i1LTI1 nJ Coq <br /> OWNER ADDRESS yp�t <br /> CONTRACTOR !^1 �",L C-e-1��V'�pA)Me— - L <br /> ; -rr — PHONE 3�-037 <br /> c{O-• W- O A44- S'�• aD 1 CSA <br /> CITY/$TATFIZIP <br /> CONTRACTOR ADDRESS <br /> LICENSE ❑C-42 ❑,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION- Coordinates X �# 1 <br /> PERC TEST # L BUILDING PERMIT# LAND USE APPLICA I IOREPAIR/ADDITION D ENGINED/ALTERNATIVE <br /> TYPE OF WORK: ❑ NEW INSTALLAT ON Fj DESTRUCTION <br /> C REPLACEMENT <br /> ❑ COMMERCIAL ❑ OTHER <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE NUMBER OF EMPLOYEES: <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG fl <br /> DISTANCE TO NEAREST: UJELL <br /> ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM)w <br /> N <br /> #OF LINES LENGTH OF LINES <br /> ❑ LEACH LINES <br /> [i LEACHING CHAMBERS FOUNDATION— -� <br /> UNDATION ft PROPERTY LINE <br /> DEPTH <br /> DISTANCE TO NEAREST WELL ft LENGTH B,mf <br /> ft <br /> ❑ FILTER BED WIDTH ft PROPERTY LINE 4 <br /> DISTANCE TO NEAREST WELLft FOUNDATION ,_ ft 7 ?018 <br /> ft LENGTH ft DEPTH <br /> ❑ MOUNDED WIDTH It PROPERTY LINE �I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION IF _(L, COUA� <br /> ft LENGTH ft DEPTH �f(" �/,/,q iyry <br /> ❑ SUMPS WIDTH It PROPERTY LINE Nn <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ff T�FNT <br /> ft LENGTH ft DEPTH <br /> ❑ DISPOSAL PONDS WIDTH ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl <br /> WIDTH It DEPTH <br /> ❑ SEEPAGE PITS NUMBER ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TT I LAPPS AND RULES AND REGULATIONS OF SAN N ALCORAQUIN ANCE COUNTY. 97 SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE <br /> MINIMU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 ( (—I'3 r <br /> ,�� Q GONsI/L i>C1jT DATE <br /> SIGNED TITLE <br /> tO Z i <br /> ED— <br /> r EPARTMENT U O <br /> Date Area Employee ID# <br /> Application Accepted By roved b <br /> Final Inspection By Date ❑ SPE AL PERMIT-App y <br /> Character of Soil to Depth of 3 Ft: <br /> Pit/Sump Soil Character: <br /> COMMENTS <br /> Permit! Permit ID# <br /> PE SC Received hec Amount Date Invoice# <br /> Code INFO B ash Remitted erviceRe Request <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />