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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"O FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTION'S EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS /L. ` /�/ CITY/ZIP 1661,�t/271,110 <br /> CROSSSTREET (`,nY"✓+'`�/ ��G^? APN �/ 7 PARCEyLSSIIZZE/• o <br /> OWNER NAME J/✓'7� �l C //'"V �{ /,'✓�G PHONE <br /> OWNER ADDRESS G•Z� C! 4/ AG/ CITY/STATE/ZIP <br /> CONTRACTOR �- G� /•'✓� PHONE <br /> CONCRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER r L NUMBER `- - EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ EN WEER DESIt:N /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 TYPF/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �1 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <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 It FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <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 WmTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STAT AWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M 2! O V E TICE REQUIRED FOR INSPECTIONS-PLEASE <br /> 0209)953-?697 <br /> SIGNED TITLE Cyd—/ 6 -,-^ DATE ' <br /> r <br /> __ I 1 <br /> S kN jo, <br /> I � - <br /> - - <br /> I � <br /> -* - <br /> rt <br /> r-;-r- <br /> f4-4LI1 7-1-77 4,41 <br /> ]1 <br /> Ti <br /> - <br /> __. _ <br /> �DEPRTMENTVNLYApplication Accepted By �Q US Area Employee ID#5 <br /> Final Inspection ByS ❑ SPECIAL PERMIT-Approved by j <br /> Character of Soil to Depth ot3 Ft: PI mp Soil Character: <br /> COMMENTS / t} <br /> ✓"P-d fAc, 1-7(hjp— 31 51 <br /> PE SC Received Checldt Amount Dale Perm Invoice# Permit ID# <br /> Code INFO B ash Remitted Service R nest# <br /> ZZ 07} 724 l0d oo 43 <br /> -733 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1222/2003 <br />