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I 7 YTS <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 Beat HaaeROn Awn Ye-STOCKTON CA5620S-8232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 269 963.7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> / <br /> DRESS 73 Q4Z/PY CIIYZP G/N LN Is��N <br /> JOB AD <br /> r CROSS STREET ( I�PNCLITS (A'�•'1IJ APN PMCEL BBE I <br /> OWNER NAME W4C{ PNONE &' <br /> OWNER ADDRESS CT'/STATEMP <br /> ('�Ibal Va(�cc �e�o c PHONE 20`t" �� gO�'7 <br /> � LONIRACTOft /' �J J /.1 <br /> CONTRACTOR ADDRESS �3/^ "'SbN rJ�Id's CMISTATEMP <br /> LICENSE frX-62 Q] OTHER NUMBER '9 r "PIRATONDATE <br /> ery <br /> WpTERTABLE DEPnI: I[ GEOORAPNICAL INFOmAATN]N: COorltNlatea X <br /> I] IW <br /> E EST T ! BDILOING PERMIT# - LAND USE APPLICATION# <br /> PE OF WORK: C N ❑ ENGIEErDESIGxFO/ALTaiNNTNE <br /> RIN <br /> WLSAj <br /> PAMN <br /> ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCNIL Cl OTHER <br /> N MBE LIVING UNITS: <br /> I " NUMBER BEDROOMS: �/ NUMBEROFEMPLOYEES: ^1 <br /> Id SEPTICTANK TYPFUMFG ('4"e"AC /�ff L CAPACITY /1000 gal NGFCOMPARTMENTS <br /> _ ❑ GREASETIUP TYPF/MFG CAPACITY gal Ii OFCOMPARTXTNTS <br /> DISTANCETONEAREST: WELL it FOUNDATION K PROPERTYLME ft <br /> ❑ LIFTSTATION SOE TYPE OF PUMP O PKG TX PLANT 0 SANDOILSEPARATOR(ENCLOOSEDSYSTEM) <br /> i LEACH LINES 0 LEACHINGCHAMBERS 90FLMES LENGTH OF LINES oG --_ N <br /> DSTooce TONEAREST WELL F3UNDATION SD, 6 PROPERTY LINE 1/12 R <br /> ❑ FILTER BED Waml R LENOW R DEPTH R <br /> DISTANCETDREAREST WELL it FOUNDATION ft PRGFE IJNE ft <br /> ❑ MOUNDED MTH R LENGTH it DEPTH ft <br /> ` DISTANCE TO NEAREST WELL 11 FOUNDATION ,_R PROPERTY LINE N <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH ft <br /> D15TMCETO NeST WELL R FOUNDATION It PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDIN It LENGTH it DEPRI it <br /> DISTANCE TO NE m WELLR FOUNDATION-ft PROPEL LINE it <br /> x � yylpm 3 ' _ n DEPOT s ' rt <br /> l,� SEEPAGE PITS Nunown T <br /> DISTANCE TO NEAREST —_=7 R FOUNDATION I ��I R PfrG.1LINE fl <br /> HEREBY CERTIFY THAT I NAVE 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 /> MINI YM 2 t I4OUR ADVANCE NOTICE REQUIRED FOR INSPEC/TIONS-PLEASE CALL(209190-7697 <br /> SIGNED l TfTLE C 0110`7 4?a, DATE <br /> V S O <br /> L — <br /> ----------------- <br /> e. <br /> C <br /> ---------------- <br /> M <br /> ' DEPARTMENT U E LY }y <br /> Application AccvP " Data,-� Area Empro ea by <br /> Final IlnPveOon B Data ❑ SPECIAL PERMIT-Appmvetl by <br /> See Character of SDII to of 3 FC Sump Soil Character: <br /> COMMENTS <br /> aa. <br /> PE SC Recvivol CheckN/ Amount Date PaR.1" Invoice Permit[Do <br /> Cotle InFo B Cash Remittetl Service Ra uest# <br /> /J z7e <br /> alE/3�3L�4 <br /> ONSITE WASTEWATERTRTMNT SYSTEM PERMIT <br /> 10 U1 <br /> 10l•IIOT <br />