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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> _ NON-REFUNDABLE PERMIT �C� P <br /> ALL 2099 953-7697 FOR INSPECTIONS EXPIRE <br /> S 1 YEAR FROM DATE ISSUED <br /> '�— JOB ADDRESS 15-15 /'tE • E `/y pA&t�QT -D' CITY21P L-01> 1 /1 ZT 0 y <br /> CROSS STREET T�rV�7LLy C IPI V I/ 0SIZE1� 0 PARCEL SIZE <br /> OWNER NAME f�f�t�-CTOT t�j-VI� L1/r C.�C�J� � .S�tk �lC PHONE <br /> U <br /> ` <br /> OWNER ADDRESS SAm _ CITYISTATE/ZIP J <br /> `r � ` y(L L_* 3tnr7-y31S <br /> [[��r� il <br /> CONTRACTOR L�(V� �p.�r` ���eqV/, D��t'v , r, PHONE <br /> CONTRACTOR ADDRESS T a, w• O AY- ST. CITY/STATE(ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE J <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y CI <br /> PERC TEST #- - BUILDING PERMIT# LAND USE APPLICATION# z <br /> TYPE OF WORK: CINEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DE IGNED/ALTERNATIVE T <br /> C REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER ) S <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: � <br /> Iy M <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS I� Q <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft 11L I <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) lrJ C t <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS It OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It (Y\ Q <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH It O <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft V <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Cl SUMPS WIDTH ft LENGTH ft DEPTH ft V� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft 2 <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft 1 <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE ft 7 <br /> I HEREBY CERTIFY THAT I 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 /> IMUM 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 Ci <br /> SIGNED TITLE G 6NSV t� DATE <br /> AYMENT <br /> ECE'IVED <br /> EP 10 2019 <br /> S JOAQUIN COUNTY <br /> -ENVIRONMENTAL <br /> ti E)3 LTH DEPARTMENT <br /> DrPARTMENI,US70NLY <br /> Application Accepted By Date Area Employee IDN 'fin <br /> Final Inspection By Date ❑ SAL ERMIT-Approved by E I`V.E D <br /> Character of Soil to Depth of 3 Ft: Plt/Sump Soil Characte. <br /> COMMENTS <br /> nrr 14 2019 <br /> PE SC Received Check#/ Amount Date Perm iU Involce# Permit ID# <br /> Code INFOCash Remitted Service Re uest# <br /> �z z - ��4 y VIRONM NTAL HEALTH <br /> PERMI SERVICES <br /> 42-Oi ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />