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ONSITE WASTOVATER TREATMENT SYSTE '� PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEP .TMENT 600 E M)WREET-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 jq:T057P,4 D CITY/ZIP 40D/ fSC242- <br /> CROSS STREET �OOD R/D G APN DSI /70 PARCEL SIZE 1. 2—.5-14 C o <br /> OWNER NAME zI S, CA-N i7A Ge 1,,VVR L.4.ND PHONE o2 oo J 4-2- <br /> OWNER ADDRESS 2-0L6 S AL- ):?A V P-0 A-D CITY/STATE/ZIP /- Lop / 95-2-4-2- <br /> �� <br /> CONTRACTOR �is��Y �l/�!/���L h PHONE to r/� T'O3 <br /> CONTRACTOR ADDRESS P � O 1� 7 CITY/STATE/ZIP <br /> LICENSE ❑ C42 ❑ C-336 BOTHER NUMBER EXPIRATIO <br /> WAT R TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Er PERC TEST # BUILDING PERMIT# LAND USE APP CA I <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ER DESIGNED/ALTERNATIVE <br /> ❑ 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 gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ 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 ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CER THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORD CES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE /® - 2 07 <br /> T <br /> /11 <br /> L <br /> 7 <br /> SAN jbA <br /> N IR N <br /> �. <br /> DEPARTMENTUSE ONLY - - PgF7 T <br /> Application Accepted By Date V Area Employee ID# <br /> Final Inspection B Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS +rJ (D 0064 eD <br /> TSS <br /> PE SC Received he Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> ;da 5 5?7:7 <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 05/30/2007 <br />