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I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOIIIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAN STREET-STOCKTON CA OS202-(209)468d 20 <br /> NON-REFUNDABLE PERMIT CALL(209)9$3.7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1J 0: C-;! ae.a4, � c CDY6o L�J•-\•• yV� i1 y <br /> CROSS STREET GI. h <br /> Bp4G/.-a `C. APN �'AI IZO pX PARCEL SpR Zi7F• g <br /> OWNER NAME 1 _ !`S 1 T '-1� PHONE IA <br /> OWNERADOREWf U Q(JX 1 - CRY/STATE/ZR <br /> I <br /> CONTRACTORo \`�' pp PHMe <br /> T CoNTRc:ToE ADDRE6B�`. 1J2r <br /> .L4�TT, ♦) 'l - Cm ''``"�ISTATEZP Le�' �NT Ta <br /> LICENSE 13C-42 DC-116 OTHER NUMBER EKPRATNJNDAR <br /> I <br /> WATERTABLEDEPTN: ft GEOORAPHIGLIMFORMATgN; Cowdinabe X Y <br /> PERC TEST # BUILDING PERMIT)K LAND USE APPLICATIONN 1) <br /> TYPE OF WORK: ❑ INM IflALLATDN ❑ REPAIRIADIRDOM ❑ NOWEER DEWIMDIALTERIIATNE <br /> ❑ RVLAOEtm1T ❑ DESIxIHCTHON <br /> _- INSTALLATION WILLSERVE: ❑ RESIDENCE L1OM <br /> CMERCaI ❑ OTHER <br /> NUMBEROFLMNGUNITS: NUMBEROFBEOROOMB: NUMSEROPEMRWYEEB; IW <br /> ❑ SEPTIC TANK TYPEJMFG CAPACRY gal #OFCOMPARmEHT3 C <br /> ❑ GREASE TRAP TYPEIMFG CAPAQTY gal #OFCOMPARTMExTS <br /> DISTANCETONEAREST. WnL ft FOuxDATON R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PIGS TX PLANT O SANDOILSEPARATOR(ENCLOSEDSYSTUA) <br /> O LEACH LINES ❑ LEACHING CHAMBERS #OF LINER LENGTH OF❑xEs R C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft P ERTYWNE ft <br /> ❑ FILTERSED Wim ft LENGTH ft DEPTH It ml, <br /> DMI TO NEAREST WELL ft FOUNDATION fl PROPERTY UNE It <br /> O MOUNDED W. R LENGTH It DEFTHft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY UNE It <br /> ❑ SUMPS W. ft LENGTH fl DEPTH ft r <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft. <br /> ❑ DISPOSAL PONDS WImH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE R ` <br /> O MBE <br /> SEEPAGE PITS NOR Warn R EPTH DIt �- <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It. PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQJW COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> STONED TITLE . <br /> I' . f._A'A- DATE <br /> e. <br /> NI <br /> I <br /> DEPARTMENT E LY <br /> ApPllotlon Aewpl.a By Dols G V O� Area Employ., # 73 ! - <br /> Final Inspection By Deb ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 R: PK Stomp SWI Character: <br /> COMMENTS <br /> Coda INPo CtlN Sed Did. SRvia= asst# Invoke# PNmN 9M <br /> I .Jzzz ssl ? X61 3 34a.00 Rf J^ <br /> A 01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />