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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1865 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> TION-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPEC77OAtP1RES 1 YEAR FRDM DATE ISSUED <br /> Jog ADORESs=+ F H u'tGLI+ns¢IP1 0!8 C"IZIP CA 615 <br /> +z� <br /> CROSSSTREET Il�u$�.1! A APN �S'1+�a`I,. � PARCEL SIZE d 0 n' L+�— <br /> OWNER NAME CiV►f:'S (/-V) &-cf,Y'1i.-In-� 1 PHONE_5! '�*Q'I <br /> OWNER ADDRESS J� CRYISTATEMP7 <br /> CONTRACTOR 140-fC c5 $44 4:4 --sd - PHONE <br /> CONTRACTOR ADDRESS .----CITYISTATEFAP G'fl < <' ` <br /> LICENSE QC-42 [jC-36 OTHER I NUMBER IG73q <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Cowdltlnf s X Y <br /> U PERC TEST M BUILDING PERMIT#- LAND USE APPLICATION# <br /> TYPE OF WORK: 6F NEW INSTALLATION 1 REPAIRIADCTRON I. EHOINEER DESIGNED/ALTERNATIVE <br /> ;} REPLACEMENT ! OUT-OF-SERVICE SEPTIC SYSTEM I DESTRomoN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE WICOMMORCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOAAB: NUMBER OF EMPLOYEES: -3 <br /> 0"'SEPTiCTANK TYPE/MFG T`r1— _ CAPACITYla>1� gel 9OFCOMPARTMENTS—'�--_ <br /> ❑ GREASE TRAP TYPF1MfG CAPACITY gal P OF COMPARTMENTS <br /> t <br /> DISTANCE TO NEAREST: WELL If 06 R FOUNDATION, .S it PROPERTY LINE I m ft <br /> ❑ LIFT STATION SIZE - TYPE OF PUMP ❑ PKG TX PLANT IO SAND OIL SEPARATOR(ENCLOSED SYSTM <br /> ❑ LEACH LINES `I LEACHING CHAMBERS M 6F LINES LENGTH OF LINES ft <br /> �/ DISTANCE TO NEAREST WELLIt FOUNDATION` _it PROPEPTYLINE it <br /> iF il.TERBED WIDTH 33T It LENGTH 30.S ..—it DEPTH I I IF It <br /> DISTANCE TO NEAREST WELL jQ0+ tt FOUNDATION?-ri I ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH It LENeTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION tt PROPERTY ONE ft <br /> ❑ sumps WIOTN It LENGTH _.._.�R DEPTH It <br /> DIStANCE YO NEAREST WELL it FOUNOATION-- ft PROPERTY UNE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY"NF R <br /> Q SEEPAGE PITS NUMBER WIDTH It DEPTH R <br /> DLSTANCE TO NEAREST WELL ft FOUNDAr K)N ft PROPERTY LINE it <br /> I 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-nEASE CALL 209 953-7697 <br /> SIGNED T1TLE Gars j-!'ce±Is C— DATEE- - <br /> ]- ' <br /> LG <br /> t <br /> F <br /> _D <br /> 013 <br /> al <br /> oulvry <br /> —g <br /> AL <br /> 44 HENT <br /> P RTMEN US NLY / <br /> ApplicntlonAccepte r+� +` Date Area C1 " Employee loge S <br /> Final Inspection Onto 1 f-1 SPECIAL PERPAIT-Approved by <br /> Character of Soil to D h of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS -- <br /> PE SC Received hack#1 Amount D 1 Permltl� Invoice N Permit IDR <br /> Gude INFO B Cash Remitted Sarvlce Request N <br /> 4tIL 2sa I539 0 — 6 20 <br /> 42-01 ONSITE WASTEWATFR TRTMNT SYSTEM PFRMET <br /> 4/!4119 <br />