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ONSITE WASTEWATER TREATMENT�SY.STEM-PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT BOG E MAIN STREET-STOCKTON CA95202-(209)468-MO <br /> NON-REFUNDABLE PERMIT CALL1(209k9§3-76971FOR INSPECTIONS EXPIRESI YEAR FROM DATE ISSUED <br /> f 6 JOBADDRESS l �, aE�InISPIV A-L/ CRYIYIP_ ZA-10tJ e-A 95.37-0 <br /> j` CROSS STREET 1 +ti /� rh APN 2-e-5 YO-0 PARCELSIZE l9.4F7�!j i <br /> OWNER NAME �++ ��'�� rC'(3[`� _--PHONE 469- <br /> FOWNER ADDRESS h'I^t CrrYISTATvMP <br /> CONTRACTOR •�• � S r�,e� PHONE <br /> ComwmuOR ADDRESS J��VL+1yL Cm ^%lISTATE21P IngotV Z 9!;-;) 1i <br /> LICENSE QC-a<2 UC-39 OTHER .4 NUMBER qOX�n 9 EXPIRATION DATE <br /> a <br /> f <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: CoordiNd" X Y ` <br /> tAENG PERMIT# LAND USE APPLICATION# <br /> 0 PERC TEST 0 F_6�61 1 <br /> I TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADOITION ❑ ENGiNEER DESIGNED 1ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OFSERVICE SEPTIC SYSTEM ❑ DESTRUCTNON <br /> INSTALLATION WILL SERVE: `1 RESIDENCE 0 COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 17 SEPTIC TANK -TYPFJMFG CAPACITY gal #OF CoupvnuENTS �3 <br /> Q GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 1 <br /> F Q LIFT STATION SIZE TYPEOFPUMP Q PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYS?EM) l <br /> hl <br /> LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES tic R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft i <br /> (� FILED WIDTN�R LENGTH ft DEPTH �1 ft <br /> DISTANCE TON ST WELL. ft FOUNDATION ft PROPERTY LINE R <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMP$ WIDTH ft LENGTH R DEPTH R <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH R LENGTH It DEPTH ft C <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PAOPERTYLINE ft ry� <br /> E7 SEEPAGE PITS_ NumaER WIDTH ft DEPTH ft <br /> —DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <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 REGULAMNS OF SAN JOAQUIN COUNTY. <br /> MI <br /> NIMU HO VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 5209)953-`7697' �t <br /> ��, SIGNED TITLE Ci>sLtNI��'� DATE <br /> I <br /> Fi <br /> f 1 <br /> In I <br /> F <br /> Q I <br /> EDL AL <br /> P E <br /> l <br /> IF 1 <br /> i I <br /> ~ <br /> r.DE.PARTMENVU E 9N-Ly—..------ I <br /> FDate Area Employee ID# OFinal By Date ❑ SPECIAL PERMIT_Approved lry Cha of SaIl to pth of 3 Ft: PI ump Soil Character: <br /> Co Ts qLe t dr_2 6-f <br /> PE SCReceived Ch Amount PN rmW <br /> 1 <br /> Code INFO B ash Remitted Date Service uest# Invoice# Permit ID# <br /> y.IQ 11S �• 3 23 0.r� l� -SJP 00$- <br /> I <br /> 42-01 - ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> F !2'88 !09 <br />