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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUI]COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46&3420 <br /> NON-REFUNDABL .PER rT CALL 209)95,31-7697 FOR INSPECTIONS EXPIRES 1/Y�EAR FROM DATE ISSUED <br /> JoB ADDRESS —T / CITY/ZIP (/ y <br /> CROSS STREFT ry�� AJ,P�J PARCELSIZE t <br /> OWNERNAME " ./�� PHONE t !r <br /> OWNER ADDRESS <br /> CITY/STATE/ZIP <br /> (0� W-PHONT 6/i/-96,07 <br /> CONTRACTOR 9 ,n7CONTRACTOR <br /> CONTRACTOR ADDRESq'� S <br /> CITY/STATEIZIP <br /> LICENSE )� C42 ❑ C-36 OTHER A NUMBER 1�!t 51� EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # _ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: O NEW INSTALLATION 0 REPAIR/ADDITION !NEER DESIGNED/ALTERNATIVE <br /> C1 REPLACEMENT x UESTRUCTIOIn <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UMTS: 'NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> R.M <br /> SEPTICTANK TYPEFGTo14 P / r {L—L. CAPACITY _ gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFG CAPACITY gal #OFCOMPARTMEN7S_ _____. <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LtNF tl <br /> ❑ LIFTSTATION SIZE TVPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft Qrn <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft T j <br /> ❑ FILTERBF.D WIDTH_ ft LENGTH ft DEPTH ft C ! <br /> DISTANCE To NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft � 11 <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH R <br /> DISTANcF To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft E <br /> ❑ SUMPS WIDTH_ ft LENGTH ft DEPTH ft <br /> DisTANCE`FO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R L ; <br /> O DISPOSALPONDS WmTR ft LENGTH ft DEPTH it <br /> DISTANCE TON EAREST WELL R FOUNDATION ft PROPERTY LINE ft , <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R 1 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O INANCES,STATE LAWS AND RULES AND REGULATION'S OF SAN JOAQUIN COUNTY. <br /> :MfINI U C \ ICE REQLTRED FOR I\ 9!JS-PLE L(209)953-7697 <br /> SIGNED�i11�/UCJ� -� T[TL DATE <br /> i <br /> I <br /> I <br /> j 1 <br /> i <br /> i <br /> I I <br /> Curr <br /> NVR NSEN <br /> HE LT <br /> El <br /> — <br /> DEPARTMENT U E ONLY �{ <br /> Application Accepted B Date 2 �8' D Area Employee ID# -5 - <br /> Final Inspection By Date 13 SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 Ft: Plt/Sump Soil Character: <br /> COMMENTS 5�1�7/C t //} �i1s� ?1 ' S.7. .4W,— <br /> PESC Received Che6 I Amount �..DateJ Permit/ Invoice# PermitlD# <br /> Code INFO By Remitted Se <br /> 'fzzl ops s7�- vo.a� Roo 3 <br />