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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 800 E MAW STREET-STOCKTON CA 95202-(209)468420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREss �7 /L C' - Ctrr21P rn 9saa a y <br /> / p n yam- L� tJ <br /> CROSS STREET_ �JST/N F APIAO�J-�W��! PARCEL SIZE O AK o <br /> O <br /> OWNER NAME_A)(J Aj qC- t 5 PHONE y° <br /> OWNERADORESS p R^ CITY/STATMP <br /> CONTRACTOR \t\��_ i�� �^ A55,c cC Niz5 NONE_M CO"-2�73 <br /> i CONTRACTOR ADDRESS Mll E ?6412=- 9N, c��/ppa CRY/STATEJLP�� <br /> 4 `\ LICENSE QC-42 QC46 OTHER NUMBER -Q'7-1 0 1 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 ❑ ENGINEER DESIGNED/ALTERNATIVE 111 <br /> ❑ REPLACEMENT D OUT-OF-SERVICE SEPTIC SYSTEM 6,-❑ DESTRUCTION \1 <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIALT�� ZyyS ✓6 OTHER/ V <br /> NUMBER OF WING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> O GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #of LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION it PROPERTY LINE .ft \ <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE ft <br /> Q MOUNDED WIDTH it LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH It 'LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE It <br /> ❑ SEEPAGEPITS NUMBER WIDTH _ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION It PROPERTYLINE it <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 /> I' 4 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2 9)953-7697 <br /> TITLE, !96-/Ib6'CL/ DAMk/6P <br /> a <br /> Lu <br /> z <br /> o <br /> ' ~ AYMENT d) i1A <br /> 2010 <br /> al <br /> i IYY <br /> 4-w DEPARTMEN�E ONLY' <br /> �! Appllwtlon Acte -- - Dater- <br /> Are,4dao//� Emplo}ee_ID# T <br /> uw �- <br /> Final Inspection Date /3 ❑ SPECIAL PER Approved by <br /> Character of Soil tcfDepth of)Ft: Pit/Sump Soil Character: <br /> COMMENTS /9_d� 00a�7 <br /> PE SC Received C Amoun! Date PartmU Invoice# Permit IDN <br /> Code INFO B ash Remitted Service R Uest# <br /> L)c'- <br /> I42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> I 6/26109 <br />