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1, 'Ali ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CDUNTY ENVIRONMENTAL HEALTHDEPARTMENT 1868E.HAMILTON AVENUE-STOCKTON CA 95205-(209)4689420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUED <br /> JOB ADORES$ YSS/ EAST /r/L4TLX7n/0>oN AD. Cm2P J/hpAA/1 L4__ 95337 <br /> CROSS STREET y_.-AV 1TLd __.- APN_.2f'7- �O"''�B PAAAOEEL SQE_ 2o Ao / ,,. a <br /> OWNER <br /> OWNER ADDRESS <br /> �F_1,fAM,�_..—..__.._ _CNYISTATE21P <br /> CONTRACTOR_ LffESMPy CAUSu LT/At4 ._.__.__.__....._____PHONE <br /> CONTRACTOR ADOBES$ __11?. 0- R-vx 379* _.___.._. _).____p. _CmhYATERIP <br /> __1/rCR COCK 'I'JJB� <br /> LICENSE "C-42 r, -M OTHER R.C. E NUMBER _ 75---74,,,EXPIRATIONDAYE__�// <br /> WA R TABLE DEPTH:_�S._.. 8 GEOGRAPHICALINFORMATKRI: Coordinates X____, Y__ <br /> PERC TEST #�_ __ _ _._, I BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAIPIADDRION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTIoN <br /> INSTALLATION WILL SERVE: i, RESIDENCE .] CowERCIAL '.; OTHER _ <br /> NUMBER OF LWINO UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TwEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY pal #OF COMPARTMENTS_ <br /> DISTARCETONEAREFF: WELL _ It FOUNDATION X PROPERTY LINE 8 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP___,.G PKG TX PLANT 01 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> D LEACH LINES LEACHING CHAMBERS _____. IOFLINES_ LENGTHOFLINEB __R <br /> DIsTaNCE TO NEAREST WELL -- N FOUNDATION—lit PROPERTYLINE 8 <br /> ❑ FILTER BED WIDTH K LENGTH K DEPTH 8 <br /> DISTANCETONEAREST WELL _K FOUNDATION M PROPERTYLINE K <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH K <br /> DISTANCETONEAREBT WELL It FOUNDATION H PROPERIYUNE it <br /> ❑ SUMPS WIDTH it LENGTH _..__ K DEPTH N <br /> DISTANCE TO NEAREST WELLR FOUNDAt10N K PROPERTY LINE K <br /> ❑ DISPOSAL PONDS WIDTH If LENGTH_ K DEPTH ft <br /> DISTANCE TO NEAREST WELL___ X FOUNDATION ..__R PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBERWIDTHit DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION k PROPERTY LINE B <br /> 1 HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OADINANCES, <br /> STATE LAWS AND <br /> RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> M/ 4 HOU ANCE NO IR FOR OF <br /> ECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED _. __ TFILE._QL✓ DATE <br /> R 34 it <br /> ..._.- <br /> ,�/ -7- <br /> REPARTUENT USE ONLY _ <br /> Application Accepted B _ ;/t/ ___._______ Date_4 ! / __— A. ��._. Employee ID#rK6CG <br /> L. <br /> Final Inspection By ate 41Y,�r ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to M o W Fk: PNlSump Soil Chveeter. <br /> OMI}AENTS <br /> PE SC Received eck Amount D to PermH/ Invoke# Pernik lD# <br /> Code 1NF0 B Remitted Serviu Re unt# <br /> Vzzz 336 It R�(P9 Zy <br /> d2-0i ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> a V12 <br />