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t //" 30 <br /> r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1866E.HAZELTON AVENUE-STOCKTON CA 95205-(2D9)468-5420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR lNSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoBADDRESS_fg S/ EAST w"rc.4/NSoA112pCM/zIPInAA/TECA 9533 <br /> CRosSSTREET/_. AusT:Al_R .'.__ APN_157- i id_�__. PARCELSUE 20 Ikc <br /> OWNER NAME_jr2ML{_._Y_ _�j1.KC1�.JJ✓�tE.� -- -PiKINE 1s5.�- 3461 '. <br /> OWNER ADDRESS <br /> ^-.'S Mme. -,l_ __ CffY/STATF/ZIP ____ <br /> CONTRACTOR. CAa.CHIP-))(CAk!5UA-TI T(f PHONE- 6.4g IRc? <br /> CONTRACTOR ADDRESS p. O• 9oJC 79�{. ___Cm/STATE2@ 'rug cocl2 '?5339( <br /> LICENSE jC-42 'JC-36 OTNEp R.C. E NUMBER 7s+--EXPIRATION DATE— -/t�__ <br /> WA RTABLE DEPTH:- "' IS ft GEOGRAPHR:ALINFORMATION: Coordinates X_ Y _ <br /> PEPC TEST # I BUILDING PERMIT# _ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATKIN REPMR/ADDITHHI ENGINEER DESIONEDIALTERNATWE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION_ <br /> INSTALLATION WILL SERVE: ;.) RESIDENCE COMMERCIAL G OTHER_ <br /> NUMBER Of LIVING UMTS: NOUDEROFSEOROOMB: NUMBEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEWFG _ CAPACITY gal #OFCCMPARTMENTS <br /> DISTANCE TO NEAREST; WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP__D PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH ONES LEACHING CHAMBERS <br /> #OF LINES__ LENGTH OF LRIES�_-------- ft <br /> DISTANCE TO NEAREST WELL K FOUNDATION ,-ft PHOPERTYUNE it <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELLIt FOUNDATION N PROPERTYUNE it <br /> ❑ MOUNDED Wettx ft LENGTH K DEPTH it <br /> DIDTANCETONEAREST WELL _ K FOUNDATION It PROPEPTYLINE It <br /> ❑ SUMPS WMYN K LENGTHfl DEPTH K <br /> DIBTANCETONEAREST WELL R FO#IDAHON ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH--ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL N FOUNDATION B PROPERTYUNE_ it <br /> ❑ SEEPAGE PITS NUMBER.._._._ ..-.._ __ WIDTH _ ft DEPTH it <br /> DISTANCE TO NEAREST WELL___ it FOUNDATION It PIKIPERTY LINE it <br /> I HEREBY CERTIFY T14ATI HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MMLA44 TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953- <br /> SIGNED_ TITLE_ DATE 4-14.64 <br /> N IR E TA <br /> All <br /> zm <br /> DEPARI'MENT UAE ONLX ��� <br /> Application Accepted S - r Deis pF}; <br /> _¢ I �� Area T EmPIDyse ID#TA(6<s <br /> Final InsPBDllon By Qte .1; ❑ SPECIAL PERMIT•ApProvetl by <br /> Character of Sail to DIWthe Ft-. PMUMP Soil Character: _ <br /> CO ENTS <br /> PE SC Received sc Amount PermPo <br /> Code IBe B as Remhted D ° Servke R asst# Invoice# PsrmH ID# <br /> 'fiZL 336 IL -k�o 2 <br /> 4201 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 424/12 <br />