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I *-* ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL j209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS z/zal WFSTe-,RAn/T L//V6 RD CITY/ZIP- TRACi/ 9530¢ U <br /> CROSS STREET mOUNTR/N flOu F P4RX WR APN_dog-/9o-33 PARCEL 512E a0/41 vi <br /> 0 // <br /> OWNERNAME PYARAw 5-1-1114PHONE 7riz-Z�f/-o3Y7 <br /> OWNER ADDRESS 4/0Z Lt/E$7' �r2AN%-G/NF /PD CIN/STATFJZIP ZeAcy S'^ y-iZc4 <br /> CONTRACTOR PROVOfT->:� Pe/TLfNA/ZD CONJULT/n 6 (/Rocs? PHONE- 1G9-�OL-/ZS2 <br /> CONTRACTOR ADDRESS d9o/ S/fK ,2r>-� 5a/rF /02 CITY/STATE/ZIP CR 9SS fG <br /> j LICENSE y,C-42 LSC-36 OTHER Q-C. E_ <br /> NUMBER C754'7 f EXPIRATION DATE 6/'/ <br /> P�WA R TABLE DEPTH: `� D It GEOGRAPHICAL INFORMATION: Coordinates X y <br /> _ # f BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION _ ENGINEER DESIGNED!ALTERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: - NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE $ <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES _. LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ FILTER BED WIoTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST 'WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, K <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 'I' <br /> / f 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 I <br /> SIGNED TITLE/Q/NAPA Z,6.✓Q/A/EfK DATE <br /> P JG N T <br /> I1 I <br /> I <br /> ( N o D f <br /> m1i <br /> I LL <br /> a ►� 7 -771 <br /> E <br /> r <br /> I A E I <br /> "r. <br /> 1 <br /> DEPARTME4U E O LY <br /> Application Accepted By -- Date d �r Area Employee ID# <br /> Final Inspection By Date 7 11., SPECIAL PERMIT-Approved 6y <br /> Character of Soil to pth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#t Amoun! Pea uest Invoice# Perrnit ID# <br /> Code INFO B was I� Remitted Dam Service Re # <br /> '}Z-2.Z 5 i! s �)—--�2 'S.�'-0 01.E — <br /> i <br /> 42-Cl ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10,14107 <br />