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VNJl i t VVA,i twATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLE PERMIT /CALL 209 9533-7697 FOR INSPECTIONSExPPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4�Q.S ,J"!-1N I� 1 I"� CITY/ZIP. L^o'Lk—L-rVg—L:s /pS-Z-3- <br /> CROSS STREET 7 I Lti77-l��� 1Z'/ �-7Oy� - / `APN I - �Zv_ O ARCEL S¢E <br /> OWNER NAME_ <br /> PHDON>E <br /> OWNER ADDRESS _;>c—D iii /NE S-.7 Sly" yL-c-C>C ATE/MP I G3)i^31 <br /> CONTRACTOR LIVE OA-Y— 2PHONE <br /> CONTRACTOR ADDRESS 40 3- Vj S-F- CITY/STATE/MP lt-oT) I��IZI.2 <br /> /Z <br /> � <br /> C7 <br /> LICENSE GC-42 GC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDrnON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �144 <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ytk,J � <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft � <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH , O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 10 <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ✓ R <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE h 0��+ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TSTAHIS IAPNS AND RULES AND REGULATIONS OF NE IN ACCORDANCE <br /> COUNTY. <br /> SAN JOAQUIN COUNTY ORDINAN ,F;R�T�N�, <br /> ' MINIMyis�24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r �F/y�, <br /> SIGNED F /�L. TITLE C ONS'VL I ANT DATE 17, -t0 -(rT <br /> ; . <br /> 517E P-AN 1► <br /> EPARTMENT USE ONLY <br /> Application Accepted By Date Area.`/?Z"/ Employee ID#� <br /> Final Inspection By Date ❑ SPECIAL PPERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By, ash Remitted ServiceRe uest# <br /> 5 /-7 11410 S ( -7�&' , <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />