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// 2c= <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENUWONMENTAL HEALTH DEPARTMENT 600 E MAW STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS �t E:XPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS " o a eA"J/`��L �^ CITY/ZIP /�'t�+•�tiJ y'ry� '�/ m <br /> CROSS STREET 14 0-n �t opt f'A" APN W a �4- PARCEL SIZE o <br /> OWNER NAME ( 7 e "4(( PHONE A <br /> OWNER ADDRESS 117)- 7 PA CITY/STATEIZIP <br /> CONTRACTOR_ PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP j <br /> LICENSE UC-42 EC-36 OTHER NUMBER EXPIRATION DATE 11 f1� <br /> WATER TABLE DEPTH:_ it GEOGRAPHICAL INFORMATION: Cocrdinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# �J <br /> TYPE OF—WORK7 NEW INSTALLATION = REPAIRIADDITION IJ ENGINEER DESIGNED!ALTERNATIVE <br /> L REPLACEMENT 7 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESDENCE �. COMMERc1A1 C OTHER <br /> NUMBER OF LNG UNITS' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG_ CAPACITY 92.1 #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEJMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL _,------_ ft FOUNDATION____-. ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPEOFPUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ® LEACH LINES = LEACHING CHAMBERS #of LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONft PROPERTY LINE C ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNCATION_ ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it 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 UNE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ it DEPTH ft <br /> DISTANCE TO NEAREST/ WELL ft FOUNCATION ft PROPERTY LINE R <br /> ](� SEEPAGE PITS NUMBER 1 WIDTH I ft DEPTH <br /> J� DISTANCE TO NEAREST WELL ft rOUNCATION ft PROPERTY LME & - ft <br /> I 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 /> MINI AUR ADVANCE NOTICE REQUIRED FOR INSPECTIONSr PLEASE CALL(209)953.7697 <br /> /xn/it/rJ� DATE-7 <br /> SiGNE TITLE —u <br /> J <br /> I <br /> k ti <br /> I I <br /> aa+i • ct( <br /> R1 T <br /> a ,- <br /> M (MC <br /> • o /Lre. � r �1 <br /> I I O <br /> I � <br /> t) p <br /> DER TMENTUS ON <br /> Application Accepted 8 ate I Area Employee ID#-ez � <br /> Flnal Inspection By. Data SPECIAL PERMIT-Approved by_T_ <br /> Character of Soli to Depth of 3 Ft: y� Pi Character: <br /> COMMENTS (�� <br /> 36•� <br /> _'�1Lt3Gr��Z' <br /> P SC Received Check#f Amount rITI Invoice# Perm It ID# <br /> Co@a INFO B Cash emitted Dam Service R uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERI <br /> 1014107 <br />