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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAU JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95206-(209)468-3420 <br /> NON-REFUNERMI CALL 209)953-7697 FOR INSPECTION EXPIRES f DATEISSUED <br /> MD <br /> JOB ADDRESS /AL�_�. • 1,../F.r'�� q/Crt{/,Y��ZP <br /> CROSS STREET O } Ate-i 5"(- APN l F 3�2, iO — 17 PARCEL SIZE G 3 <br /> v <br /> OWNER NAME // PHONE t , <br /> OWNER ADORE 5 .. CTYISTATE21P <br /> 11)15 <br /> CONTRACTOR 1 1, y� PHONE <br /> CONTRACTOR ADDRESS 'J. - k CITYISTATE21 <br /> LICENSE XGd2 C-36 OTHER A NUMBER l EXPIRATIDNDATE - <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATICN: Coordinates X Y <br /> U PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: - NEW INSTALLATION x REPAIRIADDITION ENGINEER DESIGNET <br /> REPLACEMENT OUT-OFSERVICESEPTIC SYSTEM DESTRUCTION I <br /> INSTALLATION WI LL SERV E: RESIDENCE '..I COMMERCIAL //� I1 OTHER no <br /> NUMBER OF WINGUNRS:� NUMBEROFBEDROOMS: l�— <br /> NUMBEROFEMPAiN�`ftNH�y��p��� <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY 991 11OFCOemwl(Ni➢TCY N� <br /> ❑ GREASE TRAP TYPERv1FG CAPACITY gal #OFCOMPANTMENTS PAgi. <br /> DISTANCETO NEAREST: WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> w LEACH LINES Y LEACHING CHAMBERS E 40 OF LINES LENGTH OFLINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYLINE it <br /> ❑ FILTER BED Mom It LENGTH it DEPTH 6 <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED YWDm ft LENGTH % DEPTH 8 <br /> DISTANCETO NEAREST WELL it FOUNDATI a R PROPERTYLINE 8 <br /> SUMPS YNOm ft T DEPTH it <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDm ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION S PROPERTYUNE it <br /> O SEEPAGEPITS NUMBER WIDm it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE B <br /> 1 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 /> M HOAIR QA=EJ"1C&REQUIRED FOR TIONS SE CALL 209 9 3- 697 <br /> SIGNE L, TITLEUjj DATE <br /> LVJtN1 <br /> tI. <br /> e <br /> 1 <br /> d <br /> r <br /> Uwj <br /> p¢�ETq 0�4T�L�yy <br /> Application Acce DEPARTMENT <br /> J Date j � Area Employee ID# <br /> Final Inspection y Data L1 SPEC)AL PERM -Approved by <br /> Character of So11 to th of 3 Ft: Pit/Sump Soil Character: <br /> Czl a 7- <br /> PE SC Received C AmountDale Pe"IV Invoice# PermR1D# <br /> Code INFO B ash Remille Service Re ue31# <br /> l I L 2�k2 ° 5 200 3 3 <br /> to ub Ow SLLwp iw5 Fat' a -esti tZtn IK P I o tzss5 <br />