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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 /> PION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS O I Yti d ClrvtZlP u <br /> CROSS STREET L v"\ APN �"'/ > <br /> +/yy y�_ {,, PARCEL SIZE d• 9 <br /> i OWNER NAME i,A f'TY'Y/1'1 PHONE 4 <br /> OWNER ADDRESS CITYISTA1yIT^riZIP <br /> CaNTRACraa �y(] e� r'�• j'1 PNONH �l <br /> CONTRACTOR ADDRESS J) Cr ryISTATE1Z <br /> LICENSE QC-42 QC36 OTHER NUMBER-13121!____EXPIRATION DATE ry <br /> T V <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdinatn X y <br /> ❑ PERC TEST # BUILDING PERMR# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAWADDITION V ENGINEERDEmNEDIALTERNATWE <br /> G REPLACEMENT U DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENC :1 COMMERCIAL-` _ OTHER <br /> NUMBER OF LPANO UNIT$: NUMBER OF BEDROOMS'' NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMF CAPACITY IS gal #OFCOMPARTMENTS <br /> CJ GREASE TRAP TYPEIMF / CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE NEAREST: WELL/ ft FOU TION ft PROPERTY LINE ft <br /> Q UFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS #oF LINES LENGTH OF LINES ft <br /> DISTAN EST WELL ft OUNDATIONft PROPS YLNE }t <br /> FIL EO WIDTH EAft LENGT,�I ft DEPTH_ t Z r ft <br /> DLiM TO NREST WELL ------ k FOUNDATION U It PROPER? UNE <br /> Q MOUNDED WmrN ft LENGTH ft DEPTH <br /> DISTANCE To NEAREST WELLft <br /> ft FOUNDATION ft PROPERTY UNE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH <br /> D18TANCE TO NEAREST WELL ft <br /> R FOUNDATION ft PROPERTY LINE ft <br /> O DMPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> O SEEPAGEPITS NUMBER WIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft <br /> R FOUNDATION ft PROPERTY LINE_ tt <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIM COUNTY ORDINANC@S, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> • MI UM 24 HOUR ADVANCE NOTICE RECtUIRED FOR I CTIONS-PL (►,4E LL( )953.7697 <br /> NED �l I' <br /> TTILE ZI.Y DATE job <br /> I <br /> l <br /> I <br /> I <br /> + y , <br /> I <br /> t <br /> NT <br /> I <br /> J A <br /> i <br /> Application Accepted By EPARTMENT SEJ <br /> Gate 71 tp Area Employee 10# <br /> Final InapeCtton By Daft 11SPECIAL PERMIT-Approved by <br /> Character Of Sol l to pth of 3 Ft: P Ump Soil Character <br /> M N1 <br /> COEA1TS C� <br /> n'L. - <br /> SC <br /> Code INFO Re Rived Chec Amount Date pe it/ <br /> as amiaed Service R U"t# Invoice# Permit IDN <br /> 0 4 <br /> 42-09 <br /> 1014407 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4 <br />