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Ad <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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 37 t� �p[.T',Gf= •�..�. �TLCr y zip Y- 9saa d <br /> CROSS STREET�J5T//" F 11 APoO_Jy--oC W--1 PARCEL SIZE P0 AR- o <br /> 0 <br /> z <br /> OWNERNAME NEi>�r s PHONE w <br /> OWNER ADDRESS CITY/STATE)ZIP <br /> r�rTlJlO pc(tC� <br /> CONTRACTOR \\ ��_ 4pJpi Kt Q /�,- rnL OpC.-1��s PHONE_3flJCD' 3 r -�7'076Z <br /> I CONTRACTOR ADDRESS CITY/STATE/ZIP 4C <br /> I <br /> I � <br /> LICENSE [�C-42 �.CJ6 OTHER NUMBER Ssgy8q EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 7 PERC TEST # BUILDING PERMIT IX LAND USE APPLICATION# — <br /> TYPE OF WORK: 7 NEW INSTALLATION C REPAIR/ADDITION L ENGINEER DESIGNED/ALTERNATIVE 11 <br /> L REPLACEMENT 0 OUT-Or-SERVICE SEPTIC SYSTEM r L DESTRUCTION <br /> INSTALLATION WILL SERVE: 7: RESIDENCE COMMERCIAL��=ly!j X61 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS \ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITYgal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE R tl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft \ <br /> ❑ FILTER BED WIDTH ft LENGTH 14 DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH It DEPTH it \ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH _ft DEPTH f, <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ^ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ,�\J <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I' F 4 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2 9)953-7697 <br /> iTITLF�X lQES/6 6•�ll� � DA TY\ '� /0 <br /> N <br /> o R, <br /> s� <br /> z��LLIQ� <br /> I- <br /> PAYMENT <br /> l <br /> z o �- P_CETVE13 <br /> L3i j 2010 <br /> 4 - Q� p7 <br /> 4,W DEPARTMEN U E ONLY <br /> • Application A..1.6— <br /> _ - _ - Date _ a��/� _ _ Area - Employee ID# <br /> Final Inspection f Date �/3 !d SPECIAL PERMIT-Approved by <br /> Character of Soil td Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> _G<^'"'��fb>v�S �a✓Lr/S/.✓�_¢.c-pJB�F�/�P�r/�'1S. -£_c�� - -----.._.---- <br /> PE SC [Received C Amount i Date Permit! Invoice# Permit ID# <br /> Code 'NPO B ash Remitted TService R uaex# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 6/26/09 <br />