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IV ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> _ SAN JDAMiN CWNW ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202.1209)468-3420 <br /> NON-REFUNDABLE kRMIT ACAAILL 209 953-7597 FOR INSPEC77ONS EXPIR 7 YEAR FROM DATE ISSUED <br /> E. /Gt CITYRLP ` 2� <br /> JOB AooReae //'' rr..--��..�� ��s�.�[L /nL�_ww ��LL�/// _ ��// yy <br /> CROSS STREET C \s;.j.. /�TQ APN (:256—��,0* PARCELSIZE b <br /> OWNER NAME A(ftpPx-dE M./l W��T9FU PHOU <br /> PHONE <br /> i <br /> OWNER ADDREss /T•�• BOX ��Vn CITYISTATLI21P 4-11"Oy •/ -752 <br /> D/ 6 <br /> CONTRACTOR L"" G �IJf/K/�y y6.. PHONE (20) 33¢-66/3 <br /> CONTRACTOR <br /> CONTLTOR ADDRESS .O. 00A 2/L50 CIWISTAMZJP ��/ - •S I <br /> LICENSE QC42 QC-36 OTHER NUMBER EI04RATSM DATE <br /> IERTABLEDEPTH: R GEOGRAPIRCALINFORMATION: Coordinates X T Q <br /> PERC TEST • BUILDING PERMIT LAND USE APPLICATION <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/AODITION ❑ ENGWEERDE9IGNEDIALTERNATNE <br /> ❑ REPLACEMENT ❑ OUT-0F-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATONWILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMMEROFEIMNOOMS: NUMWROFEMPLOYEES: <br /> O SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OFCCMPARTMENTS <br /> DISTANCETONEANEST: WELL R FWNOATON R PROPERTY LINE ft <br /> ❑ LIFTSTA71ON SIZE TYPEOFPUMP ❑ PKGTXPLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> .� ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTYUNE R <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE ft <br /> O DISPOSAL PONDS WOTx R LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NuaeER Mm R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE 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 /> MfNIMUM 2 ADVANCE NOTICE REQUIRED FOR INSPEAAT�IOaNS�-L PLEASE CALL 209 953.7'9A7 <br /> SIGNED TITLE_r. _�By VI•Faal GATE —�T—�/ <br /> L 41i-' <br /> I 2 <br /> R X <br /> I R EIVED <br /> RaIaJ 3.,�"k <br /> _ aliJ <br /> )LI <br /> xM ox sN w <br /> Applicii ACceMal�v.a/�IN{~� Date �-s/ r �J�2/� Area EmPloyea IOR <br /> Final Inspection By / / - / Date (oJA'Y ❑ SPECIAL PERMIT-Approved by / <br /> Character of Soil to D tll of 3 FU FPI ump Boli Chareetar: <br /> COMMENTS ' <br /> Ze` 1 <br /> LP713 "1 /10 <br /> PE SC Received Gash m <br /> AaNM Date PermH/ Involea# PHTnk 104 <br /> Coda INFO B RannitOs0 SomIm Regmat• <br /> Z27- S a58 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9121110 <br />