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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 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS lJ�Sr� / u./ /� CITY/Zfp 1/1 <br /> i <br /> CROSS STREET LlbtI/.ST TW�F APN 'F:7 PARCEL SIZE y <br /> 0 <br /> v <br /> OWNER NAME d/J IAK'�e PHONE qtr - <br /> OWNER ADDRESS CITYISTATEIZIP <br /> CONTRACTOR ;7 PHONE �z-7 <br /> CONTRACTOR ADDRESS CITY/STATEZP <br /> LICENSE 14-42 L.C-36 OTHER NUMBER yS�S'G'YS EXPIRATION DATE �/1I3/NL <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 17 NEW INSTALLATION , REPAIRIADDITION r ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT IJ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION hL.D ThnkZ <br /> INSTALLATION WILL SERVE: Ll RESIDENCE A COMMERCIAL CC OTHER l?2e—Atj <br /> NUMBER OF LIVING UNITS: /J NUMBER OF BEDROOMS: q�,,' NUMBER OF EMPLOYEES: <br /> &I- SEPTIC TANK TYPEIMFG�f Via! CAPACITY .417e/ gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL SD it FOUNDATIO it PROPERTY LINE 7T' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> (b LEACH LINES LEACHING CHAMBERS III OF LINES a�l LENGTH OF LINES 7y R <br /> DISTANCE TO NEAREST WELL 73' ft FOUNDATION l;;L ft PROPERTY LINE Ley ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> fl SEEPAGE PITS NUMBER ;I WIDTH ft DEPTH IaS, R <br /> DISTANCE TO NEAREST WELL J/9- R FOUNDATION /X1 ft PROPERTY LINE �:el ft <br /> 1 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE j9�h/ <br /> I� <br /> 17y . <br /> PAYMENT- <br /> Al InfrT.2_ <br /> N <br /> L <br /> !CI <br /> EPAR ME T E NL �f <br /> Application Accep 1 Data Area Employee ID# <br /> Final Inspection by' '!•�^ ___ _.__ Date //�f%-. -1 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS LOT <br /> PE SC Received Check#/ Amount Date PermiU Invoice# Permit IDN <br /> Code INFO Remitted Service Re uest# <br /> p 242. 021 �I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9/21/10 <br />