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/ ONSITE WASTEWATER TREATMENT SYSTEM PERMIT L �g05�Z <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> t. <br /> NON-REFUNDABLE P1 ERMIT CALL 209 953-7697 FOR INSPECTIONS E <br /> wXP <br /> /IRES 1 YEAR FROM DATE ISSUED <br /> �4 <br /> JOB ADDRESS 1 <br /> CITY/ZIP C `+o <br /> Rol <br /> v) > <br /> CROSS STREET P�i�il��i� 'Roach AP 08 1 - 1 (PC)—f 9 A 4CEL a <br /> /��l�,,,,(��,,((pp������ ,7 r I���y c- q y� Dp�py�'y��,� --7�.,�•,�t/1 11,1.i` ' �/t�j� PARCELSIL _... .3� p <br /> OWNER NAME Agdl lMl SCI�I7cM�7i 1-.T�LCI Inc,, 1V1�,,,/}()�It I IPJLQIL.{I� T V0.tz F-i7M I Qmj'it�V I,K,hmltl,E�',,�tti./kq (� 2 <br /> OWNER ADDRESS ] f l Q(-lyU��`'�r�1y���/�/IVI O E& /U B CITY/STATE/ZIP IPPf Ui�'Jll/� ,)l t I C—A- -1�2✓ <br /> CONTRACTOR NCIH O 1 1 1(/�1Y�1t,1/d'J'rC1�1{-yj is-,`U/U. I Y ICS• PHONE `✓- 'l� _; (& / -/3 /(0}, <br /> CONTRACTOR ADDRESS lu 1✓,A /1 1 i a I ""Y /ZI <br /> ///tyy� ( <br /> CITY/STATEP ✓�`� <br /> LICENSE ,IC-42 LC-36 OTHER �_S NUMBER VL /CCC///tN EXPIRATION DATE b6 A;0 I <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> PERC TEST If BUILDING PERMIT# LAND USE APPLICATION# O KS) <br /> TYPE OF WORK: F NEW INSTALLATION - REPAIR/ADDITION C ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT D DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE I. COMMERCIAL 11 OTHER <br /> i <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEJMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It <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 n N <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft v <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft w ` <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WOTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ]t <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH n DEPTH ft }f+ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ h, <br /> ❑ SEEPAGE PITS NUMBER WIDTH n DEPTH ft . <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 /> IMUMM R ADVANCE NOTICE REQUIRED FOR INSPECCTT1'ONS-PLEASE CALL(209)953-7697 <br /> SIGN <br /> J�� -`--�'" TITLE V ��f'{t r DATE Z 2-10 <br /> +� TENTAT�IV r�ARCEL MAP � <br /> ­00t.�; � -_ Y D <br /> i /[ r- �r'.u� SA J A UI C UNTY <br /> AL <br /> KT <br /> ' DEPARTMENT U E OY <br /> ` <br /> Date <br /> Application Aceepte7Lo Y Area Employee ID# <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> Character Of Soil to pth of 3 Ft: PiUSump Soil Character: <br /> COMMENTS , / /iii ,2� <br /> PE SC Received Chec feount Permit/ <br /> Code INFO B CashittedOate Service R uest# Inv°ice# Permit ID# <br /> 5. �I� <br />