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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3"E WEBER AVE-3"FL-STOCKTON CA 95203 .(209)168-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR MOM DATE ISSUED <br /> JOB ADDRESS C 1 CRWZIP I A <br /> CEDER STREET 1 r 1. APN PMCELSHE <br /> OWNERNAME 1 4 -\ la PHONE / `'Q <br /> BIBB OWNERADDEFRi - - 1 1 - T , CITYISTATF/ZR - <br /> CONTRACTOR PHONE �" I <br /> CONTRIROR ADDRL¢S - CDV/STATUZIP <br /> r LICENSE ❑C42 ❑C36 OTUER NUMBER EXPIRATION DATE <br /> WATERTABLEDEFOU fl GEOGRAPRIGLINPORMATION: CBOrdhUd" X Y <br /> O FERC TEBT 0 BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: 'NEWINEFAITION ❑ REFAIR/ADBRION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ` ❑ REPLACEMENT ❑ DESTRUCTION <br /> IN .[ON WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMB ER OF LIVING UNrtS: NUMBER Of BEOROOME: NUMBEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACRY Sal 80F COMPARTMENTS <br /> ❑ GREASE TRAP TVPF/MFO CAPACRY R01 00TCOMPARTMENTS <br /> ❑ PEG TX PLANT DISrANCETONEARBEO WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ LIFT STATION SHE TYPEOFPUMP ❑ SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> ` ❑ LEACH LINES ❑ LEACHINGCHAMBERS #01LINE9 LENGTH OF LINES ft <br /> DISANCETONEARESr WELL ft FOUNDATION It PROPERTY LME ft <br /> ❑ FILTER RED Wl. ft LENGTH R DEPTH H <br /> DL9'fANCETONEAREST WELL ft FOIINDATpN R PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH R <br /> DISANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH fl LENGTH R DEPTH ft <br /> DIm"u TONEARFSE WELL ft FOUNDATION It PROPERTY LINE ft <br /> ` ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETONEAREBT WELL R FOUNDATION R PROPERTY LME fi <br /> ❑ SEEI�AGE PITS NUMBER WmTx R DEPTH a <br /> DISTANCEMNEARESE WELL It FOUNDATION It PROPERTY LINE R <br /> `I I HEREBV CERTWV THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTV <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM N HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL 11041953-7647 <br /> ` SIGNED TITLE DATE a <br /> V <br /> Alla <br /> LLJ <br /> L � <br /> E <br /> DEPARTMENT E/ON <br /> Mt. /UUS/ I O 7 Arca EmPloyw IDR <br /> � APPllutl4e Accepted BY , <br /> FDA hHwfl.e BY Date ❑ SPECIAL PERMIT-Approved by <br /> Character of SDII m Mpth DO FU PIUSump Soil Chamckr: <br /> COMMENTS <br /> PE SC Rettived Amoeet Mte Perm1U Invoke# Permit wo <br /> Cede INFO B CUB Remitted Servke cep# <br /> IJ-0J-WI ONSITE WASTEWATER FERMI I <br />