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h , <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOBADOREss / 900 SOtATA COMrONEx lZD• CRY/ZJp MA 17WcA gsil(• <br /> CROSSSTREET PArf_ HWy /Z0 APN SLOB-/9O'Z3 PApCELS12E 6.42Ac g <br /> OWNERNAME 51-ANL6Y VANDI5k VXF.W PHONE -IF�7G/I <br /> OWNERADDRESS SIS FIRST 57- CITY/STATE(ZIP SCCA ^/ /'L 94a -2a <br /> CONTRACTOR PRadOSTC oaIfcNArzD cZIwrynsj4 Vivo PHONE <br /> CONTRACTORADDRESS 470/ Sloc RD- ♦ CITYISTATEZP MD <br /> O6STOy CA 9S3f-L <br /> LICENSE QC-42 QC-36 OTHER /<<E NUMBER C9.T,tJt EJI_NAT*NDATE <br /> WATER TABLE DEPTK: SO* It GEOGRAPHICALINFORMATION: COOrdimtes X Y <br /> PERC TEST k / BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: O NEW INSTALLAT%IN O RVAIRIADDITION ❑ ENGINEER DESAINEDIALTERNATNE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATIONWILL$ERVE: ❑ RESIDENCE LRKOOMMERCIAL O OTHER <br /> NUMBER W LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY 001 kOFCOMPARTMENTs <br /> ❑ GREASETRAP TYPE/MFG CAPACITY 9a1 kOFCOMPARTMGWS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS "LINES LENGTHOF❑NES R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE-ft <br /> ❑ FILTER BED WIDTH fl LENGTH It DEPTH ft <br /> DISTANCETONEAREST wsF R FOUNDATION ft PROPERTYLINE R <br /> Cl MOUNDED WM1OTH ft LENGTH ft DEFTH R <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION_11 PROPER UNE ft <br /> ❑ DISPOSALPONDS MOTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R FROPERTYUNE R <br /> ❑ SEEPAGE PITS NUNem 'WiDYH. -" _' _ -_ fl DEPOT <br /> DISTANCE To NEAREST WEIL ft FOUNDATION R PROPERTYLINE ft <br /> 1 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 /> mla&24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TIRE JQ.C-E • DATE <br /> El T <br /> o IN LSN <br /> R <br /> Ti <br /> �11 <br /> Applldtlon ActeDate Alva EmpWYee IDk <br /> ;tot.h <br /> Date ❑ SPECIAL PERMIT-Approved by <br /> Character of 9Ofl Ft: PIUSump Soil Character. <br /> COMMENTS s37c�IL'��dG�/�,l' B'Ib` 4'8.n..�j l)t�/ ��`� �`�32" G9nr.-y•L)T1lJN/�/lY.Y?, <br /> PE SC Reeetved Amount D.Do PatmiO Invoiw tl ParmN IDk <br /> Coda UTL CBeh Remitwi $ervkaR ueatk <br /> y-zzz su 12s aD Se00 f� <br /> 517'1 <br /> ONSRE WASTEWATFRTRTMNT SYSTEM PERMIT <br /> 4241 <br /> S2N10 <br />