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SAN JOAQUIN COUNTY PUBLIC HEALTHSERVICESENVIRONMENTALHEALTHOIVIMUN <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)4,69-5429 <br /> v l NON-R UN ABLE PERMIT EXPIRES 1 YEAR FRGS '1'E ISSUED Ir D- 2% <br /> " JOB ADDRESS V APN f--LJ �'7 .� ( _- PARCEL SIZE: <br /> CITYIZIP O BUILDING P..ITk y� <br /> OWNER NAME ADDRESS-._ILIO , ��L31S _ <br /> f <br /> CITYIZIP O ' PHONE NUMBER <br /> CONTRACTOR ADDRESS <br /> CITYIZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION d RESIDENCE NUMBEROFBEDROOMS: 2 <br /> Ef REPAIRIADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION O OTHER <br /> O ENG]NEEREDIAL7ERNATIVE - <br /> ~ N CHARACTER OF SOIL TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# - <br /> F U( 'SEPT]CTANK TYPFJMFG CAPACITY #OFCOMPARTMENTS <br /> f-� <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKC]X PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATJON SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DIFFANCETONEARE.ST: WELL - FGUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> � r r <br /> ' I L FILTER BED WIDTH LENGTH DEPTH DZWANCETUNEARcm WELL FOUNDATION PROPERTY LINE <br /> L� Cl .MOUNDED WTDTH—Z&— LENGTH-_I DEPTH DIIANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH o15TANCETO NEAR&sT: WELL FOUNDATION PROPERTY LINE P� <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DI4TA4CETONEARExT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PIT$ # DIAMETER DEPTH DIRANCETOKEARLTE WELL FOUNDATION PROPERTY LINE +nn <br /> 4` <br /> 1 HEREBY CtRTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,SPATE LAWS L <br /> tl AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR A ANCE NOTICE REQUERED FOR INSPECTIONS-PLEA$£CALL(209)468-3423 , <br /> b <br /> SIGNED: TITLE: DATE: <br /> �I I— I ]ELI <br /> .-H <br /> I r <br /> UP- <br /> ;7 <br /> Fr- . I i <br /> f DF.PARTMEN 'E0. <br /> .Y <br /> APPLICATION ACCEPTED BY'. �4-� DATE: Q LAREA-` EMPLOYEE IDN-�/T 3 9 DISTRICT --LOCAT11 <br /> BY: DAT - PERMIT FINA YES DAT V --,,,PE... <br /> INSPECTED _ <br /> COMMENTS' <br /> I <br /> PECODE SC INFO AMOUNT CHECKP ASN RECEIVED DATE PERMITISERVICE REQUESTP INVOICEP SEPTICIDN <br /> ? REMITTED BY <br /> -- 2,10 ( S V) .29-41 3�b 3e <br /> j Y I REVrsED"- l - - <br /> b x <br />