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leA-7 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 9520..2-`�99)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROIGFD T ,ISSUED <br /> JOB ADDRESS �QS' CITYIZIP ' C4 <br /> CROSS STREET l OS I C.,(0 M-IQ APN Q''� PARCEL SIZE tv <br /> r y' � tv <br /> /4 . , <br /> OWNER NAME /v O C �G�/ PHONE Q/� /'17�V� <br /> OWNER ADDRESS Z /G�d�S r CITYISTATErZIP1{,C <br /> CONTRACTOR ✓4��K+ PHONE�C]��_ `~--;?,17—'/q +— <br /> CONTRACTOR ADDRESS ��// QQ CITYISTATE/ZIP <br /> LICENSE 1.1C-42 © R C-36 OTHER NUMBER TSC/ EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> O PERC TEST # BUILDING PERMIT# 3 1:. LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION u REPAIRIADDITION C ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: N�RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG 06:3t_ref e D�P __ CAPACITY gal #OF COMPARTMENTS Z <br /> D GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE .13 ft (� <br /> O LIFT STATION SIZE TYPE OF PUMP 11 PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) "1 <br /> Z1 LEACH LINES 11 LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES 4/11 ft <br /> DISTANCE TO NEAREST WELL --Z6 ft FOUNDATIONS _ft PROPERTY LINE l_ ft <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH It DEPTH ft 1 <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft �- <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER- 3 WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _,Zad ft FOUNDATION it PROPERTY LINE /.3 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 /> UM OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 } <br /> SIGNED TITLE Il of A r.CJ DATE OZ—.2 _ �! <br /> i <br /> !r �I <br /> !3r <br /> - I � <br /> 4 <br /> IR N E <br /> lip <br /> H <br /> v' <br /> DEPARTMrNT SE ONLY - <br /> Application Accepts Date ! Area Employee ID# <br /> Final Inspection Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 Ft: P' Sump Soil Character: <br /> COMMENTS A)ex-_) r—oT <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> Y2-11 !I y-Sv.t�zJ 12b o <br /> o <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014/07 f <br />