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k V ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 862Q6,(209)468-3420 <br /> NON-REFUNDABLE PERMIT r CALL 208 963-7697FOR INSPECTIONS / EXPIRESS.1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 ,9 of /I/'IL� I� /6� CITY21P LF"<i to ` ? <br /> CROSS STREET A ar /l.(e /ZO / APN 063oy0a3 PARCELSUE IIJ b <br /> OWNER NAME G/� �04S-.0 rn��_// / PH/ONE <br /> OWNER ADDRESS I/�IIIaG� /a A/l�p ire Rr CDYISTATEIZIP SFoCkTJ1'1 gtal aZ <br /> CONTRACTOR L..IM N� U�P//V/// dITI-&� c //,,/,- /� PHONE <br /> CONTRACTOR ADDRESS / �LL 7CL:",, /� ///' CITYISTATIUZIP <br /> LICENSE 09f42 110C.36 OTHER NUMBER V5"P"p C_EXFIRATIDNDATE <br /> WATER TABLE DEPTH: IJS ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMR# S LAND USE APPLICATION# <br /> TYPE OF WORK: NEWINSTALLATH)N 11 REPAIRIADOITION ❑ ENGINEERDESIGNEOIALTERNATIVE <br /> II REPLACEMENT 'I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: REamarvcE ❑ COmME CI L ❑ OTHER <br /> NUMBER OF LIVINDUNITS: NUMBER OF BEDROOMB: /� NUMBER OF EMPLOYEES: ��]] <br /> YSEPTICTANK TTPEIMFG CAPACRY ICCOO gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPUMFG �w CAPACITY gal #oFCOMPARrn ENT6 <br /> DISTANCE TO NEAREST: WELL IoV / ft FOUNDATION CG ' ft PROPERTYLINE ed It <br /> ❑ UFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES(3) LENGTH OF LINES B0 / ft <br /> DISTANCE TO NEAREST WELL /90 It FOUNDATION 30 R PROPERTY LINE /S it <br /> ❑ FILTERBED W.-ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION B PROPERTYLINE It <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH it DEPTH It <br /> DISTANCE TO R T WELL ft FOUNDATION ft PROPERTYLINE ft <br /> SEEPAGE PITS NUMBER 3� W10TIN ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ,2LV ft FOUNDATION /0O ft PROPERWUNE <br /> I HEREBY CERTIFY THAT 1 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 /> 0 <br /> E ONLX <br /> Application Accepted By �GL Date OZ n O Area H Employee ID# , <br /> Final Inspection By Data 7h9iwn, ❑ SPECIAL PERMIT-Approved by <br /> Character of Sol lel5epth of 3 Ft: PIVSump Sell Character: <br /> COMMENTS /JBtJ Sf1Z ),IPr.TT <br /> PE SC Received Ch Amount Dow, Permitl Invetca# Permft lDk <br /> Cetle INFD Repm= 'IcP0. Least k <br /> LZ JJ7 SO /V <br /> 42-01 ONSTTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 411408 <br />