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i <br /> Gam- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3a°FL-STOCKTON CA 95202 - (209)468-3420 <br /> i NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR LNSPECTtmS EXPIRES I YEAR FROM DATE ISSUED <br /> J r dr v. <br /> -"' JOB ADDRESS i . D CITYIZW 95E3/6 <br /> CROSS STREET t`•1 F`I•r APN ��.� 1 PARC <br /> EL S17 <br /> OWNER NAME PHONE `Z 5 f <br /> OWNERADDRESS r�Jt L— /- /�..3J►�} [� CITYISTATEIZiP <br /> CONTRACTOR TIA- �pr�tt`a ,lt _� �` "116 Wc— PHONE -()60-7 <br /> ///III <br /> 95 <br /> COM1TRACTOA ADDRE55`1 L/VD W • VJ IUS0� `�" �C�IyT}yY�IS��T�ATE/Z]P <br /> Qx <br /> LICENSE -42 ❑C-36 OTHER - 615' �L" NUMBER m EXPIRATIONDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y r <br /> Q PERC TEST(S) NUMBER LAND USE APPLICATION N <br /> 3 TYPE OF WORK: X NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT G DESTRUCTION <br /> r--, INSTALLATION WILL SERVE: )0_REs[Derace ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: { <br /> $EPT[C TANK TYPE/MFG �`l.— N■L/—�7 CAPACITY /� IF gal OF COMPARTMENTS ` <br /> �i <br /> ❑ GREASE TRAP TYPE/MFG G I 6�[ CAPACITY [_J gal #OF COMPARTMENTS �`C7 <br /> n ❑ PKG TX PLANT DISTANCE TO EAAEST: WELL fi R FOUNDATION 154 R PROPERTY LINE I F ft <br /> I._ ❑ LIFT STATION siziZ <br /> tI IVAI�TVPF OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> t"1 LEACH LINES fa LEACHING CHAMBER 4U) #OF LINES A— LENGTH OF LANES t w R \ <br /> i L DISTANCE TO NEAREST WELL 2m R FOUNDATION_J�R PROPERTY LINE AD Pt <br /> ''..= D FILTER BED WIDTH ft LENGTH R DEPTH R <br /> DISTANCETO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> i. DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br /> e..,,. ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> I DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS Wtn'rH R LENGTH R DEPTH R <br /> t�•� DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> r. I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 4 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQ UIN COUNTY. <br /> �L <br /> 697 <br /> SIGNED I INIM V N NOTICE REQUIRED FORPE TIQNS- PL ASE CALL(209)95 <br /> DATE U�O�I <br /> a , <br /> n <br /> I <br /> I S" <br /> PIT AVArrrr <br /> nnk <br /> TY <br /> N iF N E <br /> ti <br /> i. DEPARTMENT E OLY <br /> Applicativn Accepted By ate [i` ArraEmployee I eJ#� <br /> Fina[Inspection By Pate g E3 SPECIAL PERMIT-Approved by I <br /> Character of Sail to lh of3 1;C Pi Sump/Soil Character: <br /> COMMENTS n j4,jjV Ild �Jt�W irrf ''tk �t%fel h k` A <br /> . ,,d-- - <br /> FFF_.. 2 7— G U Y�CP Att ", 7 <br /> ll PE SC Received heck#1 Amount Permit! <br /> Fail I—OICe# Permit IDH <br /> Code INFO B c7 ash Remitted Service uestq <br />