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ONSITE WASTEWATER TREATMr_Nr SYSTEM PERMIT <br /> SAN JOAOIAN Ca.,...V ENVIRONMENTAL HEALTH DEPARTMENT ti :4 E WEBER AVE-3"FL-STOCKTON CA 95202 -(2")469-3420 <br /> NON-REFUNDABLE PERMIT CALLq() 953-7697 FOR INSPECTION'S (E}XPIRES 1 YEAR FROM DAT�e ISSUED <br /> JOBADORESS CrrY/ZrP 4 I 9S351 <br /> t' <br /> CROSS STREET a APN c3,�r- 3 7i.1-I PARCEL SITE <br /> . -- --- ---- �1j ^� <br /> OWNER NAME C 2 tt�C'1 l l }t�.l�,}L�� PHONjIJf�LC�11 p- <br /> OWNERADDRPSS ft,�-N��- -- Cm/$TATFMP �/�Ii/L'!t✓ -_ <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑C-42 �C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH; ft CEOCRAPHICALINFORMATION: Coordinates X V <br /> ❑ PERC TEST # BUILDING PERMIT# eFI0 LAND USE APPLICATION# <br /> TYPE OF WORK: NEWINSTALIATION ❑ REPAIRIADDiT1ON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT t❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �.RFSIDEmLE 13 COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: .eje NUMBEROV BEDitOOMS: � ] NUMBEROFEMPLOYEFS: <br /> SEPTICTANK TYPEIMPG '+V f R�EM CAPACITY Ia2 gal #OFCOMPARTMENTS -, <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gai #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE"NEAREST: WELL ft FOUNDATION ft PROPERTY LANE fl <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED <br /> LEACH LINES Q LEACHING CHAMBERS_ ) _ #OF LINES'— LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY UNE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft Dwm fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS wiDTH ft LENGTH ft DEPTH It t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE It <br /> SEEPAGE PITS NUMBER WR#Tlt tQli r1 ft DEPTH t951 R <br /> DISTANCE TO NEAREST WELL !OU .at#'II' FOIINOAT[ON R PROPERTY LEVE fl <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN M 24 HOL(R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL CIA)953-7697 <br /> SIGNED TITLE DATH <br /> 1 <br /> 71% <br /> 'INOIRNI ErtrAt <br /> HEIkLT" EF M <br /> � I <br /> eff <br /> r# <br /> r + <br /> D S£ONLY `T <br /> Application Accepted ate i "'/o Area Employee 10Y5� <br /> Final Inspection Date � G6 D SPECIAL PERMIT-Approved by <br /> Charaeter of Soli to De of 3 Ft: PWSomp Soit Character: <br /> COMMENTS <br /> l� O _M C •4NC C-t- c L r.•�� L +C� "L) ZI C7 <br /> PESC Received Ch" Amount Date Permit! Invoice# Permit]DO <br /> Code INFO 6 ash RemiHed Service nest#. <br /> 42-if t17 Ysrl.d 3 L <br /> ONSITE WASTEWATER PERMIT <br /> 47-02-001 <br />