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,s ✓ <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468- 420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM BATE ISSUED <br /> IJOB ADDRESS 1CI.R/zIPI� <br /> CROSSSTREET T.-5 �r/ API�PN //�4.Z�1 V'/•� PARCEL SMEE �.J O <br /> OWNER NAME 4114 ;�/�/jQ/��L fir C� �l�{••Ai I / gZ��%55 �7�6 <br /> OWNER ADDRESS e?//uJJ'_�=,Y '�/- /6J/ �If'G/O/ S.IP ZOD CRYIBTATFZP/J! <br /> CONTRACTOR /Cl% IG/rl//� /N.I J� C�� L PHONE <br /> CONTRACTOR <br /> ,�,,ADDRESS � �n �! /�� CTTY/STATE/LP f>�h7iti ,� faf%2.to � <br /> LICENSE_,*C-42 PC-36 OTHER /4 NUMBER EXPMATmNDATE <br /> yy�1 <br /> WATER TABLE DEPTH: in -IS N GEOGRAPHICAL INFORMATION: COarDInaM X Y <br /> ❑ PERC TEST p BUILDING PERMIT# LAND USE APPLICATION#V&— <br /> TYPE OFWORK: ❑ NEW INSTALLATION REPNFIADDITION ENGINEERDESKUHHEDIALTERNAME <br /> REPLACE I. OW-OF-SERVICE SEPTIC SYSTEM )( DESTRUCTION Tan K <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE X COMMERCIAL ❑1 OTHER <br /> /� NUMBER OF LNMD UNITS: n NUMBER OF BEDROOMS: )///y NUMBER OF EMPLOYEES: <br /> b�SEPTICTANK TYPEIMFG.2 fiZ /I CAPACITYA�o I/LJ�'Oal NOFCOMPARTMENT3� <br /> ❑ GREASETRAP TYPEIMFG �� ����////C__APACITY gal p OF COMPARTMENTS <br /> DISTANCE TO NEARESTh& <br /> : WELL fL9a_F.ATION N PROPERTY LINE R <br /> (LIFT STATION SIZE TyYPPEE OF PUMP M PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 066 <br /> ✓ "LlfT.rrt� <br /> ❑ LEACH LINES i LEACHING CHAMBERS 4O LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL ft OUNDAT10N R PROPERTYONE3tt <br /> /0 <br /> FILTER BED WIDTH �� K LENGTH ` K DEPTH �7((//�� 11 <br /> DISTANCE TO NEAREST WE ' 6 NOATION U PROPERTYUNE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION 1t PROPERTYUNE K <br /> ❑ SUMPS WIDTH K LENGTH H DEPTH PA%,..--._In <br /> .K <br /> DISTANCETONEAREST WELL It FOUNDATION K PROPERTY UNE LIII <br /> L3 DISPOSAL PONDS WIDTH h LENGTH R DEPTH DR <br /> DISTANCE TO NEAREST WELL K FOUNDATION R PROPERTYLNE_nf�1_1J��It <br /> ❑ SEEPAGE PRS NUMBER YAM R DEPTH � I ZVT7 R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE IN JOAOU <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUI DEIP <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI <br /> 24HOURADVA E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7699 / <br /> SIGNED TITLE IGZS DATE �Z2-,&/> <br /> P MEN y ) � <br /> Application Accepted B Data Area Employee IDp�✓ <br /> Final Inspection By Date I L] SPE AL PERMIT-ApprOV d Dy <br /> Character of Soil to Depth f Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> �1 lI <br /> IIjIlia It, <br /> _11 <br /> "ScReml"d hec Amount DParmW Invoicep Permit IOp <br /> ash Re aunt 'vice R neat M42-01 ` C(I+s ,SITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42412 <br />