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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3M0 FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> CITY/ZIPCA q� 29n <br /> y <br /> CROSS STREET 'J <br /> APN 41_—/j PARCEL SIZE La <br /> -U52e� Q <br /> OWNER NAME T I� PHONE�J�Q� e <br /> �!^K.11 Vii <br /> OWNER ADDRESS <br /> CITY/STATE/ZIP <br /> CONTRACTOR •^/L� <br /> PHONE LV <br /> CONTRACTOR ADDRESS 1 - CITYISTATE/ZIP <br /> LICENSE ❑C-02 C-36 <br /> WATER TABLE DEPTH: OTHER NUMBER <br /> EXPIRATION DATE <br /> R GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ <br /> PERSTEST # Y <br /> BUILDING PERMIT# — LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALWTION ❑ REPAIR/ADDITION <br /> ❑ REPLACEMENT Cl❑ ENGINEER DESIGNED/ALTERNATIVE I <br /> 13 DESTRUCTION / <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL <br /> ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NGAIBER OF EMPLOYEES: <br /> SEPTICTANK TYPE/MFG FIl' CAPACITY <br /> ❑ GREASE TRAP TYPEIMFG gal #OFCOMPARTMENTS2� <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION � � <br /> R PROPERTY LME ft <br /> ❑ LIFT STATION Slze TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS 1 <br /> #OF LINES -3 LENGTH OF LINES �(� ft <br /> DISTANCE TO NEAREST WELL!A!0b R FOUNDATION�/�-� <br /> ❑ FILTER BED WIDTHR PROPERTY LINE R <br /> R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELLft <br /> R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION <br /> 13SUMPS WIDTH ft PROPERTY LINE ft <br /> R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL <br /> O PROPERTY LINE ft <br /> R R ft <br /> DISPOSAL PONDS WIDTH fl LENGTH FOUNDATION <br /> R DEPTH ft <br /> DISTANCE TO NEAREST WELL FOUNDATION <br /> SEEPAGE PITS NuMBER_ R PROPERTY LINE ft <br /> WIDTH R DEPTH <br /> DISTANCE TO NEAREST WELL ft <br /> ft FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDI NCES,ST TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NI 'I UM 24 UR ADV NCE NOTICE REQUIRED FOR INS ONS-PLEASE;CALL(209)953-7697 <br /> SIGNED <br /> TITLE DATE_C)L—1 2,,n 7 <br /> 'v`orcT <br /> ILA o <br /> � <br /> 4oe -tea' - VVI <br /> T E <br /> DEPARTMENT ON Y <br /> Application Acce Date �j <br /> Final Inspectio Date_ .. Employee ID#/EJ/p 7 A� A( <br /> 11 SPECIAL PERMIT- pproved by <br /> Character of Soil to Dep of 3 Ft: <br /> Pit/Sump Soil Character: <br /> COMMENTS 1, ) <br /> r <br /> PE SCceived bee <br /> Amount <br /> RePermit/ �q, <br /> Code Ingo B Cash Remitted Date <br /> Service Re nest# Invoice# Permit ID# <br /> 222200 <br /> 13 <br /> SPEWATER PERMIT <br /> 12 <br /> � f�E <br />