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Sriihal b'can y�i,ll� IT'ITTI <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ✓- ' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HATELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL L209 <br /> 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRO DATE ISSUED <br /> • JOB ADDRESS 100 fa <br /> Gm C"ILP N 1 S <br /> 37 <br /> CROSS STREET <br /> Hy <br /> I(X O API � PARCEL S2E p <br /> i <br /> OWNER NlJ4E Rmyrc�-/� AIv o <br /> OWNER ADDRESS [ 9!1 ;' TI��1T 1JI CRY/STATEMP <br /> CONTRACTOR >�N V ri.LLe� CHL/ C. PHONE <br /> G �e.0 NEf QI '� / K <br /> CONTRACTOR ADDRESS 3I 1 S CITY/STATEMP IU/4PL ry <br /> 0 <br /> LICENSE ❑'� C-42 ❑'/C 36 OTHER P, NUMBER�3 FQ I l EXPIRATION DAIS����- J <br /> WATER TABLE DEPTH: -N R GEOGRAPHICAL' <br /> ates X Y <br /> ❑ PERCTEST # it NFO A Coordin <br /> BUILDINGPERMIT# LAND USE APPLICATION <br /> # <br /> I YpE OF WORK: NEW INSTALLATION _ RPAIR/ADUmON i ENGWEERDESIONEOIALTERNATNE <br /> REPLACEMENT O C-0E-BERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE CONNERC AL � ❑ OTHER <br /> NUMBER OF LNING UNAS: �I NUMBER OF BEOROOMS: - NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEJMFG /'.L CAPACITYI^0U <br /> (A.�, gal BOF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY <br /> gel MOF COMPARTMENTS <br /> DISTANCETONEAREST: WELL &Q 4, ry FOUNDAII H ' It PROPEATYLINE -30 it <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP Cl PKGTXPLANT O SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OFLINES LENGTHOFLINEB it <br /> 41WNCE To NEAREST WELL It NDATION ft PROPERTY LINE it <br /> 0 FILTERBEDIbo IDTTH .'go it LEND TH gprn�uit DEPTH K <br /> DISTANCE TO NEAREST WELLO WPoUNDAXION �STJ� it PROPERTY LINE it <br /> ❑ MOUNDED mom K E.T. K DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION K PROPERTYLINE ft <br /> ❑ SUMPS WIDTH ft LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION K PROPERTY UNE It <br /> ❑ DISPOSAL PONDS WIDTH K LENGTH K DEPTH it <br /> DISTANCETONEAREST WELL K FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS Numermmmmft B <br /> DEPTH <br /> tt <br /> DISTANCE TO XEAREST WELL it FO(IHOATION it PROPERTYLWE it <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 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953.7697 <br /> SIGNED DATE <br /> G 1, 1T <br /> A. <br /> I T14 144' J <br /> 1I;,1 ( " <br /> I N <br /> 1 <br /> A <br /> Appileatien Accepted Date Area _ Employaa ID# y/D <br /> Final Inapoction By Date �/ _ ❑ SPECIAL P RMR-Approved <br /> Character of Soil to ep of B Ft: t15Ump/Soil Character: <br /> COMMENTS �(1/?.�- �.t G,.-.ten' Ike 1�"'a>r'�n•,, >.- !.-J— <br /> PE SC I Received Check#1 Amount Data -ermIt/ Invoice Permit lD# <br /> C e INFO B Cash Remitted Service Re ueat# <br /> p6 77 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4Ra12 <br />