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1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Avr-31'FL-STOCKTON CA 95302 - (209)46&3420 <br /> NON-REFUNDABLE PERMIT <br /> j LL CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR F OM 9DATE ISSUED 5�s <br /> 1 JORADDRESS 1 /Q J — _ CrrY/ZIP G J ^ <br /> �^+ d <br /> CROSS STREET �YAPNJ Dir� PARCEL SIzE <br /> -i OWNER NAME ,_J/'�I � h��J PHONE <br /> OWNER ADDRESS �� - ' y� CrrVfSTATFIZIP <br /> CONTRACTOR / � / 7��y/L PHONE <br /> CONTRACTOR ADDRESS OTYISTATFJZIP <br /> LICENSP 0 C41 O C-16 OTHER NUMBRR EXPIRATION DATE I <br /> 1y j WATER TABLE DEPTH: R GCOGRAPHICALINFORMATIOIf: Coordinates X V �J <br /> fI ❑ PERCTEST(S) NUMBER LAND USE APPLICATION If r <br /> TYPE OF WORK: * NEWINSTALLATION 0 REPAIRIADDITION O ENGINEERDUSIGNEDIALTERNATIYE �{ <br /> 0 REPLACEMENT ❑ DESTRUCTION O <br /> INSTALLATION WILL SERVE: RTSkOENCE ElCOMMERCIAL L3 OTHER <br /> L t NUMBER OR WVINO UNr1'S: NUMBER OR BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG ^" CAPACITY lY pi 4 OF COMPARTMENTS <br /> 13 CREASETRAP TYPE/MFG CAPACITY gal MOF COMPARTMENTS <br /> 4l <br />� ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft T'pUNDh710N R PROPERTY LINE R <br /> w <br /> I Q LIFT STATION SIDE TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED <br /> +.SYSTEM) <br /> 4 LEACH LINES Q LEACHI MBERS #OF LINES fo LENGTH OFL;NES , �t1 _ R <br /> F DISTANCETONEAAEST WELL _ft FOUNDATION R PROPERTY LINE .2 1I <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LIN! R <br /> ❑ MOUNDED WIDTH ft LENGTR It DEPTH ft <br /> DISTANCE TO NEAREST WELL ftl FOUNDATION ft PROPERTY LINE A <br /> 1 * A SUMPS WIDT11 it LENGTH / ft DEPTH �Q -ft <br /> I DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W1nTH ft LENGTH R DEPTH fl <br /> DISTANCETONEARLST WELL ft FOUNDATION ft PROPERTY LINE A <br /> 4 ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH fl <br /> r DISTANCE TO NEARFSr WELL ft FOUNDATION R PROPERTY LINE ft F.i i S APP <br /> 1 HEREBY CERTTFYTHAT I HAVIL PREPARED THIS AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> Ik <br /> STATE <br /> LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN CY3UNTY. <br /> 1 INIMU HO DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(204)953-7697 <br /> SIGNED [6 .. tL.n -� TITLE Cn,XrftLe, DATE <br /> --i I jgc— Isul I I I I I V 2 <br /> Ri <br /> UMA <br /> r. <br /> SN <br /> N7 <br /> tiE .21$ gt0 <br /> R NM <br />[ � 1 �J,e� DEPARTME T USE ONLY <br /> F <br /> Application A[IEepted B Date r �d Area Col Employee iD#� <br /> Final Iospectian By Date - '-'r�3 ❑ SPECIAL PERMIT-Approved by <br /> Character olSoll W Depth of 3 Ft: PtdSump Soil Character! <br /> COMMENTS <br /> PE SC Received Amount Perm ff <br /> Code INPO B hec ash Remitted D■te Semite R uest# I^voice# Permit EDM <br /> .11 I J �'r7 0 5 3356 <br /> 4201-ODI I ONSITE WASTEWATER PERMIT <br /> 1 lvzros <br /> J <br />