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39 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTION ­.Lo,-EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS q>�/Tri l �^ NL_'I Get:ALcT1 lei^ C <br /> ITY/Lw CA qcT <br /> AZT ' <br /> CROSS STREET ALAS'FT'n Qn APN ?S : 1L'IA $ PARCEL.SIZE 2.0 Ct L1�✓a � <br /> OWNER NAME Gl, r�t VOVI 6-16Yl,'.111r/T PHONE-"L!" <br /> OWNER ADDRESS So % i YYl CITYISTATEJIIPfY <br /> CONTRACTOR II! IS $4clUnP �2r PHONE 4S(,-.1RGS <br /> COfflrl TOP ADDRESS Ae 6ckx CITY/STAWMP iMen4--d 1 5,d 953.3& <br /> LICENSE QC-42 QC-36 OTIm1 it NUMBER y,[+n Ess'lZEKPIRATIDN DATE lYf 7I�7 <br /> WATER TABLE DEPTH: IT GEOGRAPHICAL INFORMATKINt Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L NEW INSTALLATION .1 REPAIRIADDITION 1. ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL D OTHER <br /> NUMBER OF LIVING UNITS: NUMBER Of BEORDOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG Ja}L- CAPAGTYfaT,.-�__ gal #OF COMPARTMENTS <br /> Q GREASETRAP TYPEIMFG CAPAGTY gal B OF COMPARTMENTS <br /> c <br /> DBTANCETOEA <br /> NREST: WELL jQyy <br /> ..{_ R FOUNDATION -S- R PROPERTY LINEI Jy�T N <br /> Q LIFTSTATION SIZE TYPEOFPUMP ❑ PKGTXPLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES 7 LEACHING CHAMBERS_ #OF LINES LENGTH OF LINES It <br /> DISTANCETONEAREST WELLIT FOUNDATION R PROPERTY UNE It <br /> 9I FILTER BED WIDTH O/ N LENGTH -1C I F It DEPTHI Q II N <br /> DISTANCE TO NEAREST WELL_]G4N FOUNDATKJFI_+26I IT PROPERTYUNE I?)01— IT <br /> Q MOUNDED WIDTN It LENGTH IT DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION IT PROPERTY LINE IT <br /> Q SUMPS WIDTH IT LENGTH fl DEPTH IT <br /> DISTANCE TO NEAREST WELLR FOUNDATION IT PROPERTYLWE IT <br /> Q DISPOSALPONDS WIDTH IT LENoYH It DEPTH IIT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION IT PROPERTY UNE IT <br /> Q SEEPAGEPITS NUMBER WIDTH it DEPTH It <br /> DPiTANCETONEAREST WELL IT FOUNDATION R PROPERTYLINE It <br /> I HEREBY CERTIFY MAT 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-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Cel f),-rlr L'C�A I- _ DATED 7 13 <br /> zu� <br /> aI <br /> t <br /> 4 <br /> s T <br /> _D <br /> 013 <br /> J A U OUNTY <br /> TAL <br /> MFM <br /> T USE _ <br /> Application Ace "A r'.� Date Arae QIlSr�l�1 EmploY'�ID#jC d <br /> Final Inspection Data L � ❑ SPECIAL PERMIT-Approved by <br /> Character of SolI to hof 3 Fl: Pit/Sump Sail Character; <br /> COMMENTS <br /> PE I SC Racalva I k#/ Amount Perm"' <br /> Coda INFO B h Remitted Gall Service Re user# Invoice# Permit IDI <br /> aalb za 75-Y.59 f&-12-11v/70R.o <br /> AZ-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42utz <br />