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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 9$202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EACPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS tL. L S K O S t t V - CTTYlZIP 'rK V%4`C IS- 0 V <br /> t+f <br /> CROSS SITREET Vu A tr 1.S LZ Z APN -Z-5-5 I(et) 2-{ PARCEL SIZE r 1 G <br /> ONt^vERNAMFI'VGf<. <br /> t7 9-Ssc1N PHONE Zc�5 32I—S Id <br /> 7 (� a <br /> OWNER ADDRESS .7 79 \ Q kk T f, CITY/STATE/ZIP / � ` I z F+ n--3 <br /> -7-7 <br /> CONTRACTOR PHONE SA-ft-4, <br /> CONTRACTOR ADDRESS CITY/STATEI71P <br /> LICENSE ❑ C42 01 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates x _ Y <br /> ❑ PERC TEST #_ BUILDING PERMIT# 0-70Z443 LAND USE APPLICATION�# <br /> TYPE OF WORK: Nr�W INSTALLATION O REPAIR/ADDITION I] ENGINEER DESIGNEDIALTER'NATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NLMBER OF BEDROOMS: CMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPF/MFG r` CAPACITY0 O p gal #OF COMPARTMENTS — <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOU\DATION ft PROPERTY LrNE { <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG Tx PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) yam} <br /> LEACH LINES ,4 LEACHING CHAMBERC #OF LrNES _ LENGTH OF LINES V ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Po, <br /> 13 FILTER FILTER RED WIDTH ft LENGTH ft DEPTH r`� <br /> DISTANCE TO NEAREST WELL ft FOLNDA"IION ft PROPERTY LINE ft V'7 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DIST. CE T NE ' T WELL OUNDATIO ft O RTY LINE ft <br /> SUMPS W TH ft LENGTH_ .Z ft DEt:1 <br /> DI ANCET 'EAREST WELL ft FOU AT'ON ft OPER E ft <br /> ❑ DISPOSAL PONDS W ' ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. - ft <br /> ❑ SEEPAGEPITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft rOUNDATION 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 <br /> ORDINANCES,STATE LAWS AND RULES A-ND REGULATIONS OF SAN JOAQUIN COUNTY- <br /> MINIM=01.R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)933-7697 <br /> SIGNED -� - TITLE`gjkJ&e/f- DATE ZZ—?V jZ7 <br /> f <br /> 21 1 <br /> nM I <br /> r <br /> (; <br /> .f <br /> U1 C OUMTt <br /> as ILI <br /> [rid lR fd <br /> DEPARTMENT U E O LY <br /> Application Accepted By Area Employee ID# �' / <br /> Final Inspection Sy _ to �r 0 SPECIAL PERMIT-Approved by <br /> Character of Sail to pth of 3 t: it! mp Soil Character: <br /> COMMS>TS A2£,-,J i•" L:,6, <br /> PE SC Received Check#/ Amount Permit/Date ["voice# Permit ID# <br /> Code INFO B a emitted Service Request# <br /> 42i3 1 S <br /> 42-Ot ONSITE WASTEWATER PERMIT <br /> 0936!2007 <br />