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/o� De-).Ly "q 21- /ws- lDAI-A� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOt11N 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 1 YEAR FROM ATE ISSUED <br /> JoBADDRESS 7-3 h Z7h,(i, 17� r_i�s 4 _ Cmrzm <br /> tt , � <br /> CROSS STREET 'Pe,I+1 Q.� E! , APN C"J'C7 -C1' �{d O- ,-- PARCEL SIxE �l- -72 <br /> ,7 v <br /> OWNER NAME_!q_YN—ql G �-• PHONE 20 4-943-540 0 <br /> OWNERADDRESS 500CE. T^✓�vlr^flr*�h;'� ��� CITY!$TATEMP ! S+ q- <br /> CONTRACTOR, CU/ IA{',t,! �L7 r 1Ll�Y -�, PHONE -e)R" J p5TB— BOO <br /> /1 9 <br /> CONTRACTOR ADDRESS Sfl �''�- _- CRY/STATFJZIP <br /> �I <br /> LICENSE !JC42 C'JG36 OTHER •+ NUMBER EXPIRATION DATE <br /> iI <br /> WATER TABLE DEPTH: �I ft GEOGRAPHICAL INFORMATION: COOfdinatS X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION X — 1.1 <br /> TYPE OF WORK: :1NEW INSTALLATION REPAIRlADDITION F ENGINEER DESIGNED IALTERISATME <br /> REPLACEMCIET ❑ DESTRiIGTION � r <br /> INSTALLATION WILL SERVE: ❑'I{ RESIDENCE COMMERCIAL ❑ CrHeR <br /> NUFISEROF LMNGUMITS: �I NUMBEROFBEOROOMS: Numsert or EMPLOYEES: <br /> i <br /> ❑ SEPTIC TANK TYPEIMFG 16(01A061- CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFGA CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETONEiIAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEIM) <br /> AR <br /> �i <br /> LEACH LINES G LEACHING C2 <br /> CHAMBERS r7 #OF LINESr w LENGTH OF I-WFS 17�`Q fl l <br /> DISTANCE TO N"9T WELL .50 fl FOUNDATION 5d ft PROPERTY LINE JTbQ/ It !I <br /> ❑ FILTER BED VVIDrH :I ft LENGTH ft DEPTH fl I <br /> DISrANCETONEiNST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft , <br /> DISTANCETONFJIREST WELL h FOUNDATION It PROPERTY LINE ft r <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEi1RE3T WELL ft FOUNDATION fl PROPERTYLINE It <br /> ❑ DISPOSAL PONDS WIDTH l ft LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL It FOUNDATION It PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER q WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fl <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 /> I <br /> NIMUM 2 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953 7697 I <br /> r <br /> SIGNED � TITLE 1'0tY`e1f/YLnca� 1'E - <br /> I , <br /> t - o <br /> 1� <br /> f <br /> I <br /> II <br /> i _ 1 I <br /> CAJ <br /> yr <br /> 773 <br /> Ax <br /> u I , <br /> ,r <br /> y <br /> l <br /> t <br /> NK 6M F AL <br /> - -— EPARTMENT USY ONL <br /> Application Acca ate` Area Employee IDIJ ' <br /> Final Inspection ' Date /D ❑ SPECIAL PERMIT-Approved by <br /> Character of Soiotopth 3 Ft: I Pit/Sump Soil Character: <br /> COMMENTS <br /> o -Zu3 Tarr/ s i <br /> PE Sc RemIv dAmount Data Permit/ Invoice N Permit IAN <br /> Code INFO By7 Cash milted5ervlce R uest N <br /> A2-0I ONSrrE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 7 011!07 I <br />