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ONSITE WASTEC TER TREATMENT SYSTEN� RMIT <br /> �J <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPART 304E WEBER AVE -J L-STOCKTON CA 95202 - (209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �„Zq-� MNP ,Gp�SQ P"DCITY/ZIP LA <br /> / Mm <br /> CROSS STREET �Y APN(39 -6&a- - -S PARCEL <br /> SIZE 3, 7 A r <br /> OWNER NAME 7iNAI1 Al4 Qf1A('\R 1,PHO1NE%s///1���\ --r�/tt�,Q <br /> DWNERNAM ADDRESS �I7 (�(J�CypZ� y I- CITY/STATE/ZIPL^�•�/•-9cP L/01 qS3 /\ <br /> CONTRACTOR Lll-� )n\f l g4' 1 M�+O[Ay), /1[. PHONE <br /> L /1-.J 1^�(oO C, <br /> CONTRACTOR ADDRESS AA(Q T- Hw y -J 1 �f'J Q�1 CITY/STATE/ZIP�d[fj,t , rA c�, <br /> LICENSE ❑C-42 ❑C36 OTHER,R` awl-lizpy- . NUMBER EXPIRATION DATE 3 -31-0-5 tOv. <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# A -A /=A51 <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPARVADDITION 1 ❑ ENGINEER DESIGNED/ALTERNATIVE ' 3 <br /> REPLACEMENT i x ❑ DESTRUCTION <br /> INSTALLATION WIL SERVE: ❑ RESIDENCE OMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: pp NUMBER OF EMPLOYEES: <br /> W SEPTIC TANK TYPE/MFG CAPACITY U gal #OFCOMPARTMENTS 21 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY---' gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL 7 S , ft FOUNDATION 10 ft PROPERTY LINE R ` <br /> LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LI LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _3 LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL IOD ft FOUNDATION, to ft PROPERTY LINE -SII ft <br /> 7 FILTER BED WIDTH R LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH <br /> � LENGTH ft DEPTH ft <br /> RCE TO NEAREST WEL FOUfI TION ft PRO TY LINE R <br /> /� 1 l <br /> SUMPS r DTN R LE'N�G+}T�FI ft DEPTH ft <br /> DI NCE TO NEAR EST WELL FOU ATION ft PRO RTYLIN ft <br /> 7 DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> �// /// DISTANCE To,NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> A SEJE PITS WIDTH ft LENGTH �, DEPTH R <br /> !X� <br /> DISTANCE Td NEAREST WELL �ft FOUNDATION R PROPERTY LINE V5R <br /> 1 HEREBY CERTIFY THA wI Hq ,q PARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 'T loft• STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M INIMUM 24H URADVANCE NOTICE REQUIRED FOR INS CTION/S--P4�+EASE CALL(209)953-7697 <br /> SIGNED � w TITLE pyy4g�y DATE ,-f D3 <br /> . '-- <br /> 0 d <br /> 9 <br /> y • <br /> w + <br /> + + I t <br /> I i- <br /> -. <br /> •V A, r I3,w - <br /> I <br /> fn <br /> �� !, /,�(/ Uc icy71 <br /> 4pplication BptEr( y � Date Area .fi/lJ Employee ID# <br /> Final Inspection By Date -f7 -p ❑ SPECIALPERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiUSump Soil Character: <br /> COMMENTS <br /> /tel d� aHf' - �af< •," „u de -. . ,' i . <br /> PE SC Received eek# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash RemitW Service Request# <br /> 721T 2 <br /> 112/11-0' ! J 7 1"a'•` K u <br /> ONSITE WASTEWATER PERMIT <br />