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f <br /> OhIS 0 E VVAS T PEVA a ER TREATMENT ENT Baas ] EM PERNT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1865 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE HERMIT r CALL 209 953-7007 FOR INSPECTIONS ,nn ,EXPIRES I YEAR FROM <br /> ! DATE ISSUED <br /> JOB ADDRESS G CITY/'LIP Y UlCi V,"�e�fA 615-J (e Sa <br /> M <br /> CROSS STREET lq ClvL C 4 APN 2�y 17.0 0 PARCEL SIZE 2 AC <br /> d <br /> OWNER NAME "Va `/ PHONE 5-10 .21C1151-095/ <br /> nn <br /> OWNER ADDRESS A711' , --4 s(/ "i e, 0K CITY/STATEIZIP ��CJ•� 7�rQ C!t / ���[7 <br /> CONTRACTOR PHONE <br /> CONTRACTOR.ADDRESS CITY/STATEIZIP <br /> LICENSE ODC-42 EDC-36 OTHER NUMBER ExPIRATIONDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT —70 OUT-OF-SERVICE SEPTIC SYSTEM 9, DESTRUCTION �L gtJilrl 24 > <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE El COMMERCIAL ' El OTHER Y <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 1=I GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> }V. LEACH LINES A D LEACHING CHAMBERS Q #/OF LINES (�/ `��J LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ' �+ V • 3 <br /> ft FOUNDATION 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 /> 0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SUMPS WIDTH rL ft LE=NGTH O ft DEPTH C D ft <br /> DISTANCE TO NEAREST WELL 2J t FOUNDATION U 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 /> �G SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION Tt 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 HO-OR ADVAS-WF NO REQUIRED FOR INSPECTIONS- PLEASE CALL2-09 953-76971 <br /> SIGNED "' i TITLE 004DATE 511119 <br /> w IQ <br /> AV <br /> Af <br /> M <br /> T <br /> DEPARTMENT LISE O N.LY <br /> Application Accepted By ___ Date Area ` Employee ID#- 1�— <br /> Final Inspection By Date ❑ SPEC L PERMIT-Approved by <br /> Character of Soi Depth 3 Ft: pittsit Soil Character: <br /> Cg'MENT r1 <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service a quest# Invoice# Permit ID# <br /> 3vO <br /> 42-01QI/ �]G ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 ���YYY /,/ G <br />