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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NONREFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS46 c �O !494 M <br /> CROSS STREET CITY/ZIP <br /> `,O . fZ0 APN 1&2-1Z o-/,3 PARCEL SIZE I I 1 <br /> / • -41 l �J �'7 C <br /> OWNER NAME � + �^IrH�` ff GPHOON�E -q'o 3 oCA­ <br /> A3 �/L <br /> OWNER ADDRESS •�� CITY/STATE/ZIP ' �J)-1 VG�'J 7J��'/V CA/ 1 S <br /> CONTRACTOR PHONE /-v U3 /4 Z-A <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑I;C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I,-; OUT-OF-SERVICE SEPTIC SYSTEM - DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIALEl OTHER <br /> NUMBER OF LIVING UNITS: I NUUM�BE.R OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> �N <br /> SEPTIC TANK TYPE/MFG 4 CAPACITY OO gal #OF COMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #of LINES LENGTH OF LINES •7S ft <br /> DISTANCE TO NEAREST WELL DD ft FOUNDATION_ ft PROPERTY LINE /O ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 1 3—2.3 <br /> I TY <br /> I � <br /> NT <br /> DEPARTMENT USE CPNLY <br /> Application Accepted B Date Area 3 ` / Employee ID# <br /> Final Inspection By Date Z _11 SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Pittsum6n Soil Character: <br /> CURAENTS /ter► <br /> _2 23 <br /> A <br /> L0. <br /> PE SC Receive Check#/ Amount PermiPermit/Code INFO Cas Remitted Date Service Re uest# Invoice# Permit I # V <br /> �„ <br /> 2// // O II•13 3 SR008341 l GjY� <br /> y-�e a 1 <br /> 42-01� ( q z4 3� OoeG"�► "" I'(, �%S7I�W7ASTEWAT� TMNT SYSTEM PERMIT <br /> anon 6. ` (/3 <br />