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ONSFE WASTEWATER TREATMENT SYSTEM PERhAff <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDA13LE PERMIT CALL 209 953-7697 FOR INSPECTIONS /��� y-�EXPIR/ESS 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITYIZIP�(,U/non 61 <br /> ty <br /> CROSS STREET APN <br /> q00& PARCEL SIZE <br /> c b�/ <br /> OWNER NAME GL Vl PHONEo� 9J r✓ ` <br /> OWNER ADDRESS 6 'LIP Q ���� CITY/STATE/ZIP <br /> CONTRACTOR DR Pt'a bu i d e e /,� L PHONE (2 <br /> CONTRACTOR ADDRESS Q I LI 11 U)G)� � ��i(C `�T CITYISTATEIZIP �CSC6 �C�s� <br /> LICENSE ❑LIC-42 ❑LIC-36 OTHER NUMBER Z EXPIRATION DATE GI— �^ 2 <br /> WATER TABLE DEPTH: 1�� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#BP-)q ONg57 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG PI L Mo i►QL.i dL rC CAPACITY gal #OF COMPARTMENTS 2 <br /> U GREASE TRAP TYPE/MFG _ CAPACITY / gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL (SD+ ft FOUNDATION Lt!(/ ft PROPERTY LINE 50 ft <br /> Q LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ® SAND OIL SEPARATOR(ENCLOSED SYSTEM <br /> LEACH LINES ❑ LEACHING CHAMBERS c #OF LINES_3 LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ISa ft FOUNDATION alb 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 /> G7 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> fa SUMPS WIDTH ft 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 IV% -rt- DEPTH ft <br /> DISTANCE TO NEAREST WELLt ft 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, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697 <br /> SIGNED TITLE DATE <br /> u t u5 <br /> r LL <br /> GI� <br /> 1 <br /> fpS <br /> DEPARTMENT USE ONLY <br /> Application Accepted y � Date 7 o7vaO Area 1 I -7� <br /> Final Inspection By Date ❑ SPECIAL PERMIT- <br /> 4R <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Ne�J (ASF(- -,er 'Co4kj— JU �L/ "j �ov���-i"��v�+e� 'UL0$ k- <br /> 04 <br /> - <br /> rr�� JOAQ i <br /> Ct9 �►�Nv1' • sC 3 ZI r L �� t�'1�H%� EALT ONMENTAL /� c� <br /> PE SC Received Check#/ Amount Permit) <br /> Date invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> NaI� ll7 S8 <br /> 42-01 �/�' I ' I� ONSITE W93TEVVATER TRTMNT SY&EM PERMIT <br />