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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLE P-E�RyMIITT Q CALL 209 953-7697 FOR INSPECTIONS Q_ EXPIRES I YEAR FROM DATE ISSUED <br /> Joe ADDRESS CITYIZIP T_r�� s-3 D {Q, <br /> CROSS STREET Lo Er+y APN 2fJr PARCEL SIZE pI• `� o <br /> OWNER NAME <br /> J G r r 1'-EN F V \W 9-1 _ PHONE �I L) _1 (01O <br /> P.C. zaX 33 S CItiISTATEIZIP PPI"` +SCJ CA `J00 <br /> OWNER ADDRESS "� q _ <br /> T <br /> CONTRACTOR 1 I t)r t t0III ��D 6&)y►QaJ MC�CA` PHONE Zlt -• L& 1 l/0-3-1 <br /> CONTRACTOR ADDRESS '-+ w• 0 pcx- ST'- CITYISTATFJZP L-OD` <br /> LICENSE . C-42 :,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> x PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ,_ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT 7, DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> I NUMBER OF LIVING UNITS NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY pal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ UFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED MOTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH tt LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It <br /> I I EREBY 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 /> MINIMU OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 p Z� <br /> SIGNED _. TITLE C.�� + �S�� ' DATE -!r u <br /> I <br /> � I L J171 NT <br /> I I ED <br /> MR 2018UNTCOYNTALTMENT <br /> ' <br /> � � I <br /> I I I 1 <br /> I I <br /> i <br /> � I <br /> I I <br /> I <br /> PARTUSE ONL /� <br /> Application Accepted By atMEN <br /> e Area ''.? Employee <br /> Final Inspection By Date .., SPEC+ IT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiVSump Soil Character: <br /> COMMENTS <br /> PE SC Received hec Amount Permit/Date Invoice# Permit ID# <br /> Code INFO Cash emitted Service Re uest# <br /> 42-0 <br /> ONSITE WASTEVVATER TRTMNT SYSTEM PERMIT <br />