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ONSITE WAST,,,VATER TREATMENT SYST' I PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DETMF:NT 304 E WLBER AW�6"FL-STOCKTON CA 952D2 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS G ��; '.;11,4--� . E. y' CITYIZIP t-,. _5 34' <br /> Ir <br /> CROSS STREET C'�'N G, APN -?`I I;I C,t L :i- C-1 PARCEL SIZE /Ll f° <br /> 11!1 <br /> OWNER NAME: �V 11,f1/ri ,t /k,n 7r� <br /> '--� --- - - PHONE: rn <br /> OWNER ADDRESS -� 'CiL //�i . ., �i' -I'rL-, Cl 11STATE//GIP W <br /> CONTRACTOR L4lYE:t' � L%�('� .1V,r'(':hl�',l.7 �s7f rt��-.�11 /• iE'T-JcS��L P14ONE •.CVI -�C. f- /Cle'`- <br /> n <br /> CONTRACTOR ADIIRF.S% 5 t CITY/STATE/ZIP .S Ir,d­;r.-, L A <br /> LICENSE ❑C42 ❑C-36 OTHER � -y'J�_/�N+Z NUMBER f;,FL��,x� EXPIRATION DATE 7-C%[• V <br /> r, <br /> WATER TABLE.DEPTH: f! GEOGRAPHWAL INFORMATION: Coordinates X y <br /> PERC TEST # PT- 3 4- P7;y BUILDING PERMIT# LAND USE APPLICATION# PA`0500 <br /> TYPE OF WORK: fia NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ <br /> REPLACEMENT ❑ DESTRUCTION (1 <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE D COMMERCIAL ❑ OTHER (r`' <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROONTS: NUMBER OF EMPLOYEES: R2 <br /> U SEPTIC TANK I.1'PIIMI CAPACIIY 9J; 11 Oh 1'( AIR <br /> U (:RE:ASF1TRAP I%I'lINII (•APATHY E.ul 11 I t1A\I�r[1 <br /> LJPKC•LX PLANT DISTANCF:'I'O NEAREST: WI�.LI,_ 11 FOA INDA I ION II �R TREY LINT' I1 `7 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #Ol:LINES LENGTH OF LINES Et <br /> DISTANCE'rO NLAKENT WrI L 11 FOUNDAHON .� 11 I'ROPEiRTY LINE <br /> ❑ FILTER BED WIDTH 11 LENGTH 11 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE-ro N):AREtir WELL 11 FOUNDAHON 11 PKOPEfRTY LINE: ft <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION f1 PROPERTY LINE It <br /> ElDISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 11 JI�� <br /> J <br /> DISTANCE:TO NEAREST WELL 11 FOUNDATION f1 PROPERTY LINE fI � <br /> ❑ SEEPAGE PITS NIIMBER WtOTIt f1 DEPTH 11 <br /> DISTANCE TYi NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> I IIF,RE.BY C'E:RTIFV THAT I HAVE;PREPARED THIS APPLICA'T'ION AND THE WORK WILL.BE DONE;IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MUM 24fflO6414 ADVANCE NOTICE REQUIRED FOR INSPECTIONS^PLEASE;CAL/,(209)953-7697 <br /> SIGNED `� TITLE A.1Cn! 7c'- A64 DATE <br /> WTF PLAN <br /> -__ ticacon R A R U 5 00 31.17511`7 LAIL5" <br /> 1 S�.T 16'59�E 419t.'J8' <br /> -tt- <br /> a , N,� MR <br /> } ,�n+e �on 1'—,fir__ 'I �, � sextslr�PM t <br /> •� . �y fit__—_-•...._ � <br /> PARCEL <br /> �. �Y •`� PF118.I1 it mVIII r �f 4 <br /> Id I <br /> 11 <br /> ►� } �{' 1 2Yf4-W `!e1 <br /> JINL <br /> 442&WJ/W si�PE"psauA EAaww V_ � � N, 1 <br /> T L <br /> NT <br /> <f<1 4m %ftL l ! <br /> 1 ,�` 6 iSffiY6m a I r/E1Nd i 1 <br /> xr[]S VIM;,s,on <br /> 11f ------ -��u�rmynin iJf3'a7"il'w'�35571' a � mraw urmornmNs�,, � k�l <br /> Application Accepted By, <br /> Date J J i (e's Area Employee ID# <br /> t r � <br /> Final Inspection By I Ir i °vi, �' Date !� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Deptb of 3 Ft: 4 Pit/Sump Soil Character: <br /> COMMENTS `� r_°� ;EIS 4Vi7H, <br /> (1 I• ,Vii ( �I�M 1� � rf I �� •�� �►; 1i`s; L�- <br /> PE SC Received Check#/ Amount Date Permit/ invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> L12.lf S") f ZZ7 S93 ViSL v O 6- Per <br /> 2 nF3 13 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br />�` 12122,2003 <br />