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• f .I <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> • SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDAB PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS 2 CITy/ZIP :tit- w <br /> t CROSS STREET 'G-7 S f APN 0(-3 -2WO-(9 PARCEL SIZE O• <br /> OWNER NAME k A-)0E e-S ir(A)Ik-NC.tA L- G-�-eL-L-C- PHONE <br /> RE <br /> OWNERADDSS Po Q D 174 /-711 CRE2W 41 <br /> Y7STATI"'tO64 To CA QS3S3 <br /> CONTRACTOR / Q7-�L 4' <br /> ^�W C/' PHONE <br /> CONTRACTOR ADDRESS r1 y //Yt��e-E W.A/_ CITYISTATEIZIP� <br /> I / <br /> LICENSE [IC-42 QC-36 OTHER ///ray NUMBER�/�nfn EXPIRATION DATE <br /> WATER TAaLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdinat" X Y <br /> i ❑ PERC TEST # BUILDING PERMIT* LAND USE APPLICATION IV <br /> —TYPE OF WORK: Ill NEW INSTALLATION 0 REPAIR/ADDITION nENGYREER DESIONEO IALTEANATrVE <br /> li O REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION.Q(-•+onJIC- <br /> - <br /> INSTALLATIONWILLSERVE: ; RESIDENCE ❑ COMMERCIAL L OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES• <br /> 91 SEPTIC TANK TYPE/MFG S�G G CAPACITY Z O 0 gal #OF COMPARTMENTS <br /> Q GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> I` DISTANCE TO NEAREST: WELL SOS it FOUNDATION fl PROPERTY LINE <br /> 0 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> O LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF UNEs R �1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> IL SUMPS, WIM R LENGTH "Z_l� ft DEPTH 1 I <br /> ��^ <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSALPONDS WIDTH S-0 ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it Q <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fi <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 /> f I <br /> MINIMU 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE �G,.J �'I",.�.,>}u�- DATE <br /> i <br /> oUNv <br /> WT,nALr-.Pcr <br /> _�.....-.,,,..-....yam _ •,.�0.E—A RT,MX-N T. St E..9,Nt-.yr .��.-sr.�.••^„+..-...-.,.+ - T r-3-q'l <br /> I Appilcedon ed By Date O Area Employee IDO <br /> Final Inspection Date f /.�' D0 SPECIAL PERM • ved by <br /> Character of Soil to Depth of 3 tv PWSump Soil CCracter. <br /> COMMENTS Oc.a e-oT OF A2,gFcv,” 5�-ACc/4t- Ac. (T ?WPB✓" . &,cs E.d k�O•J <br /> C�NSzu l�4 70 al- 00-51 W-1 n14 ��AM I�Q 1-EAcrf L–JE 5 <br /> (o-o FT- s ,d 4&!iC- r rs <br /> PE SC Received Ch*C*.V Amount Date Perm"" Invoice# Permit IDS <br /> Code INFO B aS Remitted Service Ra —I S <br /> 42�M-0IOBx ONSITE WASTEWATER TRTMNT SYSTEM PERRYT <br /> -. . <br />