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ONSITE WASTEWATER REATMENT SYSTEM PERMIT <br /> ,AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER Ave-3PO FL-STOCKTONCA 95202 -(209)#68-3020 <br /> NON-REFUND BLE PERMIT CALL(209)953-7697 FOR INSPECTIONS C EXPIRES 1 YEAR FROM DATE ISSUED <br /> I OB ADDRESS �� CITY/ZIP 2C <br /> ka�uyt 2cac1 ��/� <br /> 'ROSS STREET 1 APf'/XJI�I IPU�IIOII5 .2J PARCEL SIZE <br /> �. �� G <br /> OWNERNAME Mr. Hevit-x1 Tula PHONE T <br /> )WNER ADDRESS CITY/STATEIZIP �j <br /> :ONTRACTOft AwWmvi 1 F PHONEAll / <br /> -5761 <br /> CO A REBS CFEY/STATF/ZIP LWJ IA <br /> .ICENSE 42 0C-36 OTHER NUMBER EXPIRATION DATE <br /> %maPATERTABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> PERCTEST # BWLDING PERMIT# LAND USE APPLICATION# — - <br /> `YPEOFWORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDTTION ❑ ENGINEER DESIGNED/ALTERNATWE <br /> ❑ REPLACEMENT ❑ DESTRUCTION t <br /> h NSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL 13 OTHER <br /> NUMB ER OP LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROPEMPLOYEES: (/ <br /> 3 SEPTIC TANK TYPE/MFG CAPACITY gel #OFCOMPARTMENTS <br /> GREASE TRAP TYPF/MFG CAPACITY 891 #OF COMPARTMENTS ^I <br /> (� <br /> ❑ PKG TX PLANT DISI'ANCETONEAREST: WELL R FOUNDATION ft PROPERTY LINE It <br /> 7 LIFTSTATION SIEE TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �— <br /> BA93 LEACH LINES ❑ LEACHING CHAMBERS #OFLWEE LENGTH OF LINES R <br /> DIETANCETONEAHm WELL ft FOUNDATION R PROPERTY LINE <br /> 7 FILTER BED WIDTH It LENGTH ft DEPTH R <br /> DIETANCETONEAREST WELL R FOUNDATION R PROPERTY LME R <br /> Rama MOUNDED W.. R LENGTH ft DE.PTN ft y <br /> DISTANCETONEABFSI' WELL R FOUNDATION R PROPERTY LWE R <br /> rJ SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> DISPOSAL PONDS WIDTH R LENGTH It DEPTH fl <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER Wloro fl DEPTH ft <br /> LDISTANCETONEARLOT WELL R FOUNDATION R PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION 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 /> MINIMUM ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> IGNED E'l %TL r- TITLE DATE <br /> sg°t PA <br /> Fjr <br /> ,,n s <br /> O cs DEC <br /> A — a <br /> ^e/ bc' o E <br /> SAN J0� E 1 <br /> . ___..____� VI <br /> >_ X 437.1T 450.54' " M <br /> yi. <br /> 15180.. 811111 <br /> y A A N <br /> 17 <br /> 28 Psi <br /> •1 '� c06 <br /> omeet'ad Road _ <br /> ,�/ DEPARTMENT USE N1/Y .I S <br /> �lw— 2 ,t/Oy 216 Em rTSL <br /> Application Accepted BY Date Anm P,"D# 99 <br /> :incl Inspection By Date ❑ SPECIAL PERMIT-Approvd by <br /> ,.�hararter of Snil to Depth of3 Fc PHISomp Soil Character: <br /> COMMENTS <br /> PE I SC Recelved Ch ec Amount Date Permld `- InvoIS,IF Pumit lDp <br /> Code INFO i By Remitted So Real# <br /> J12.s2 5111 7 L 7C 1'5.00 13 )C113ieQD40 io <br /> IaHQ2-02m1 ONSITE WASTEWATER PERMIT <br /> IZIJ.Y2aBT <br />