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' }�« ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-1209)468-3420 <br /> ' NON-REFUNDABLE P�RMIT CALL 209 953-7697 FOR INSPECTIONS E%FIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 54,00/�l� r.� F•�� A <br /> P <br /> �Pw- �. c,,WzP V�^^V`s 236 �> <br /> CROSS STREET �\wajm Ao,*,d APN OSS-/SP-OZ.04 PARCEL SIZE 343 Age— <br /> OWNER <br /> g OWNER NAME /N RfDr�'IE WILL�AA� PHONE <br /> jnJa� <br /> ' OWNER ADDRESS T' � <br /> Q- s �t,�I� CITWSTATERIP L/NOEN1e4,1 <br /> p9S23G <br /> CONTRACTOR /LL4*j G AVI'LPwy 4.. PHONE lam) 331f-64 /3 <br /> CONTRACTOR ADDRESS ? 90-yAM1/ CItY/$TATEfLP �Q!/C4' <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRAnONDATE <br /> ' TER TAELE DEPTH: fl GEOGRAPHICALINFORMATIONV CDortlinates X Y t� d <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADOITION 0 ENGWEERDEBIGNEGIALTE MN <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICESEPTCSYSTEN ❑ DESTRUCTION <br /> ' INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMeMt OF LIVWG UNITS: NUMBER OF MORON IIB: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACNY gal #OFCOMPARTMENT6 <br /> ❑ GREASETRAP TYPE/MFG CAPACITYgal #OFCOMPARTMENTS <br /> ' DISTANCE TO NEAREST: WELL R FW TION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SANDOILSEPARATOR(ENCLOSED SYSTEM)) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS III _ LENGTHOFLFA_s ft <br /> ' DISTANCE TO NEAREST Vet3L ft FOUNDATION ft PROPERTY UNE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> OISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH It <br /> 1 DISTANCE TO NEAREST WELL ft FOUNDATIGJ ft WiOPERT'LINE N <br /> Illi ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCETO NEAREST wELL ft FOUNDATION ft PROPERTYUNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH IT <br /> DISTANCE TO NEAREST WELL ft mumeAnON ft PPOPERIY❑NE ft <br /> ❑ SEEPAGE PITS NUMBER NUN ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK MALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ' STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 2 ADVANCE NOTICE REQUIRED FOR INSPEC <br /> TIO <br /> `�NS�-PLEASE CALL 209 953.766977 <br /> L SIGNED TITLE rftFA•fY VIrIK HATE <br /> _.sire+ X 7C aaF' <br /> i <br /> �e <br /> 1 J <br /> IV D <br /> ON <br /> t a� n err al <br /> T <br /> 999 <br /> Application ACoep Data - Aare Employee ID; 05 5 1 <br /> Final Inspection Bp Date I ❑ SPECIAL PERMIT.Approved by / <br /> l Character of Soil to Debth of 3 Ft: PIU ump Soil Character: <br /> ' COMMENTS <br /> Zs y ! <br /> PE SC Reeeivetl ec Amoun! PartniV <br /> Co�tlTe IxFo B Cash Remiftetl Dare Service Reg.. InvoiceIf Permit IDN <br /> Z27i S 'ZriO <br /> ' I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9121110 <br /> r - <br />