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silvol I C VIII I tVVA I tR TREATMENT SYS I LM YtKM1 I <br /> SAN JOAQUIN COUNTYENVIRDNMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)46641420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7597 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11';175 W• EI6ftT:. MIl-1:' D• G clrvrzlP Si af.1GTa+J pp�, a <br /> CROSSSTRP.ET cG�o R'�EpA �Ai' APN �OI/1a.�1��Qa'1kDO��L//0PARCEL SIZE <br /> g130 r\`• <br /> . OWNERNAME STE�pE vG1•i'Nj G�R-Vo $tNLHMA'lLiG6l AICGAiRLYHONE "ST6 r3� <br /> T A 'T�C <br /> OWNER ADORE" �I z•� D(tKDftLE )�• p CITY/STAia/LP 1MDDESTD C-/1 C!'S?JS$- <br /> CONTRACTOR LtdE 0A1C- G£ ) <br /> olEf,V11zQrJwtePjTNL- PHONE <br /> CCNTRACTORADDHESS. '407 3'o• a*y— a 1 • CITYISTATE(ZIP L001, CA- <br /> LICENSE 1IC42 gca6 OTHER NUMBER ENPINATIONDATF <br /> WATERTABLEDEPIC R GEOGRAPIUCALINFORMAMON: Coordinates X Y <br /> 3K PERCTEST FFLDINGPERMtT# LAND USE APPLICATION#9A—IbODZZ:+ <br /> TYPE OF WORK: ❑ NEW INSTALLATION 1 0 REPAIRIADDTION ❑ ENGINEER DESIGNEDIALTERNATVE <br /> D REPLACEMENT 0 DESTRUCTION <br /> INSTALLATIONWILLSERVE: 0 RESIDENCE 0 COMMERCIAL ❑ OTHER <br /> NUMBER OF LNING UNIT$: NUMBEROFSEDROOMS: NUMBER OF EMPLOYEES: <br /> '❑ SEPTIC TANK TYFFIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPFJMFG CAPACITY gal #OF COMPARTA:NT6 <br /> DISTANCE TO NEAREST:I WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE T%PE OF PUMP ❑ PKGTXPLANT ❑ SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMSERS #OFUW$ LENGTHOFIANE6 R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPFRTYUNE R <br /> ❑ FILTERBED WIDTH It LENGTH It DEPTH it <br /> DISTANCETO NEARINTI WELL R FOUNDATION ft PROPERTY UNE It <br /> ❑ MOUNDED YADTHfl LENGTH it DEPTH <br /> DISTANCETONFAREST WELL It FOUNDATION ft PROPERWUNE ft <br /> ❑ SUMPS WIDTH I R LENGTH it <br /> CEDEPTH ' <br /> DISTANTONEARBSTI WELL R FOIINOAnCN ft PROPERTYLINE ft <br /> ❑ DISPOSAL PONDS WIDTH ! R LENGTH it DEPTH jT 0 <br /> DISTANGETONEARESTI WELLitFOUNDATIONRO <br /> FNDATION PPERTYUNE ft /, ' GII 01? <br /> [3SEEPAGE PITS NUMBER 1 WICTM fl DEPTH .ce.,ft <br /> DISTANCE TO NEAREST WELL - It FOUNDATION ft PROPERTYLWE Q1JINC V <br /> •- 1 HEREBY CERTIFY THATI HAVE PREPARED THIS P❑CATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINA tT DEA 7-N� <br /> STATE LAWS ANO RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> TNI 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963.7897 <br /> SIGNED TITLE CONSJ(-MWT DATE Z•Z�'1�' <br /> I � — -.._�= � ,.s HI9��. ,i 416 �:., t,y`tt•p'3 �'� <br /> Is <br /> I 14 a@A e• I j R`B :: cid :9 .1 <br /> ➢! SS <br /> ry <br /> LL-- <br /> I I I ��� t +n F"`"3fi3 •i+3tii?E'B ;': <br /> I I <br /> I I ( # p <br /> DEPARTMENU O'^Y /.��❑ <br /> Application Accepted Dale ( t Area Employee ID# 99 _ <br /> Final inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character cfSoH to Depth 013 Ft: PIUSump Soil Character. <br /> COMMENTS <br /> I <br /> `• <br /> pr SC Rec,l Od heC Amdunt Permitl <br /> Code INFO B aah Ramfltetl Data Service Request 0 Invoice# PatmltlD# <br /> 4201 ONSITE WASTEWATER TRWINTTSYSTEM PERMIT <br />