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/006, <br /> "ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 'SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH'DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT }�• : CALLL((209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATES ISSUED <br /> JOB ADDRESS ?QN1 1 �. (�Il�1ir(f 11 F•V] ;�` /CIITY/ZIP C S F <br /> CROSS STREET J�S �Iy`.�I'' 6�V^�' Q /��__ APNO J'Z1[+y/ " PARCEL SIZE9� <br /> OWNSRNAME -•qLL 1/✓w-s 1.ISAB ._Fl�l G. } PHONE /+�J <br /> OWNER ADDRESS iOS� - P(LG7�F Rp CITY/STATErZZUP <br /> CONTRACTOR PHONE LV 7 - 3(/J /0 G <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE Q C-42 0 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:.. ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> O. PERC TEST # BUII.DING PERMIT# — LAND USE APPLICATION# <br /> TYPE OF WORK: • O _ NEW INSTALLATION LI REPAIRIADDITION i D ENGINEER DESIGNED/ALTERNATIVE <br /> O, REPLACEMENT ,O' DESTRUCTION <br /> INSTALLATION WELLSERVE- O RESIDENCE O ER <br /> COMMc1AL ' O OTHER <br /> NUMBER OF LIYMG UMTS: d NUMBER OF BEDROOMS? } "cam, NUMBER OF EMPLOYEES: <br /> SEPTIC TANK r TYPE/MFG/&U1r—G90111V8 — CAPXdrY r �Z>y gal #OF COMPARTMENTS 1 <br /> O GREASE TRAP TYPF/M70 CAPACITY gal ,#OF COMPARTMENTS <br /> rDISTANC6 r0 NEAREST: WELL ./ ft FOUNDATION ..... ft PROPERTY LINE R <br /> D LIFT STATION !' SIZE -TYPE OF PUMP 4 D PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1 <br /> (3.LEACH LINES,.'D LEACHING CHAMBERS+ #OF La4m LENGTH of LINES ft <br /> 4 l DISTANCE TO NEA$EST WELL"- ft' FOUNDATION- R PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft y DEPTH •ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME ft <br /> D MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROP ERTYLINE .:ft <br /> D SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft , <br /> ' '• DISTANCE TO NEAREST' '*ELI:',. <br /> *ELI: • I' R FOUNDATION 'ft PROPERTYLINE ', ' R <br /> D SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION .•^ R PROPERTY LME ! R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WELL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY,. � '! <br /> ' ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALU 20n9)'953-7697 <br /> SIGNED ✓ TITLE <br /> a. <br /> I p <br /> 1 r <br /> 1 <br /> i <br /> r <br /> AAC <br /> U <br /> ARTMENT E O Y 9 <br /> Application Accepted Date' Area ''•� Employee 1D# <br /> Final Iespection By Date— D''SPECiAL PERMIT-Approved by <br /> Character oI Soil to Depth 3 Ft: PIVSump Soil Character: <br /> OONINMNTS0,4 <br /> ��i�✓ �T.D,4 .ted- �f�o z �. �c� :- _�- �:� <br /> I <br /> PE SC Received C e h/ Amount Perm1V Invoice# ermit DNI <br /> Code INFO Bi, a Remitted 'Date Se 'e R west# - P <br /> f1f <br /> 1 42-01 - - M .ONSITE WASTEWATER PERMIT <br /> 05/302007 h1 <br />