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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.76 7FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADORESs !22.2 ILT®N /y2 C(I�rvm/PT N h <br /> CROW STREET ISI A/�e Y1 JJ APN/I"L%-l/�ll��� PARCELSIZE� o <br /> ' OWNER NAME -TT�Vif �' DFTyUO7N / P� / PHONE p <br /> OWNER ADDRESS Z2.22Z IM1�1�- �c/V •4 CRYISTATEIZIP L-IA/IK� ] SZ3E' <br /> CONTRACTOR PHONE <br /> ' CONTRACTOR ADDRESS CITY/STATEZP <br /> LICENSE 0 'C-42 O-IC-36 OTHER NUMBER EXPIRATION DATE <br /> ' WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: COOrtl' afas % Y <br /> R <br /> ❑ PERC TEST BUILDING PERMIT It ND LAUSE APPLICATION M <br /> I YPE OF WORK: NEW INSTALLATION REFAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTN)N <br /> INSTALLATION WILL SERVE: Ip RESIDENCE ❑ COMMERCIALA ❑ OTHER <br /> NUMBED OF LNING UNITS: )j 1 NUMBER OF BEDROOMS: '(/ NUMBER OF EMPLOYEES: <br /> — <br /> UNITS; <br /> TYPE/MFG T i V CAPACITY 1-Y�O gal OOFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal NOFCOMPARTMENLS <br /> ' DMTANCETONEAREST: WELL K FOUNDATION It PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS,_ N OF LN S Z D <br /> LENGTHOFLINES *0 <br /> n�T//YY^^ <br /> DISTANCE TO NEAREST WELL t00' FOUNDATION Id+ h PROPERTY UNE _._It <br /> ❑ FILTER BED WIDTH R LENGTH ,h DEPTH N <br /> DISTANCETONEAREST WELL 11 FOUNDATION h PROPERTY LINE -e <br /> ' ❑ MOUNDED WIDTH _. N LENGTH, _@ DEPTH <br /> DISTANCE TO NEAREST WELL it FOUNDATION---it PROPERTYUNE NnI <br /> ❑ SUMPS WIDTH It LENGTH R DEPTH Z�181 <br /> DISTANCE TO NEAREST WELL N FOUNDATION N PROPERTYUNEAR GAS Q IT <br /> ❑ DISPOSAL PONDS WIDTH N LENGTH _R DEPTH lf vEALTH. N7n�i'�IT <br /> DISTANCE TO NEAREST WELL K FOUNDATION N PROPERTY UNE <br /> SEEPAGE PITS NUMBER ti WIDTH It <br /> DEPTH 4- It <br /> DISTANCE TO NEAREST WELL nom-+ K FOUNDATION IJ� h PROPERTYLINE�Q 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 JOAOUIN COUNTY. <br /> MINI M2 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> T <br /> ' N <br /> TME ONLY ����(/�'T <br /> Application Accepted By Date_I I Area Employee IDN <br /> Final Inspection By tq Dene I L1i$/11 LI ECALIT-Approved by <br /> Character of Sall to Depth of 3 FL Yzj PIt/SUmP Sail ChamCtan <br /> ' COMMENTS <br /> PE SC Received he Amount Permill <br /> — Date Invoice N Permit IDB <br /> Code INFO B ash Rambled unt Service Re uee[N <br /> ' 4201 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4I2M12 <br />