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-/,?,-S' );I;.',_3-2=di-> <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL <br /> �1209 953-769/7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS_ �� ____.- -_.___Q __-1-,e -ZCffY/LP <br /> CROSS STREET APN 2 / � I ....PARCEL SIZE p/_D! S rp4 <br /> OWNER NAME_. L� C� C�Jd'C��+ 1 � PHONE <br /> OWNER ADDRESS ?' T ` /� • 4-lam •/' �_- _CrTY/STATE/ZIP 1,r,pp& <br /> CONTRACTOR C _ No <br /> PHONE ^'VX, <br /> q {Iy <br /> CONTRAC Ion ADDRESS �l Lu��`"' r CITY/STATE/ZIP Af!!!� <br /> LICENSE C-42 'Ll C 36 OTHER__A. NUMBER EXPIRATION DATE/ <br /> 1 <br /> WATER TABLE DEPTH: I 0 GEOGRAPHICAL INFORMAnow Coordinates X____,_ Y <br /> U PERC TEST # BUILDING PERMIT# _ ___ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIn/ADnIT10N ENGINEER DESIGNED]ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE is COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:__ _3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG __- CAPAC17Y gAI N OF COMPARTMENTS------- <br /> C3 GREASE TRAP TYPE/MFG _ CAPACITY,- gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION It PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS_ N or LINES LENGTH OF LINES_—_ it <br /> DISTANCE TO NEAREST WELLit FOUNDATION_—it PROPERTY LINE,F it <br /> FILTER BED WIDTH — -y_—it LENGTH— .f_.4_d _ — I it DEPTH_—Al <br /> DISTANCE TO NEAREST WELL 'OC) ft FOUNOAIKN_ ,Q— ,R PROPERI Y LINE <br /> ❑ MOUNDED WIDTH It LENGTH __-- R DEPTH H <br /> DISTANCE TO NEAREST WELL it FOUNDATION, it PROPERTY LINE H <br /> ❑ SUMPS WIDTH R LENGTH _._.--___ it DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION # PROPERTY LINE_ it <br /> ❑ DISPOSAL PONDS WIDTH __ _it LENGTH,___-- - ___ it DEPTH___ --it <br /> DISTANCE TO NEAREST WELL _ it FOUNDATION _ ft PROPERTY UNE 0 <br /> ❑ SEEPAGE PITS NUMBER_______ WIDTHf( DEPTH <br /> DISTANCE TO NEAREST WELL__ _ It FOUNDATION __ -it PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> MINIMUW24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION -PLEASE CALL 209 953-7697 <br /> SIGNED <br /> 16 j,V <br /> L1Z A <br /> JNE, <br /> tip <br /> O N <br /> EPARTh1EN7 U E ONLY TAI <br /> f� k!f ALTkt DLPAAT) � � <br /> Application AcceptePth <br /> *3t- <br /> _ _Daje 3. ( -- __ Area �y_ Employee 3 l� /6. F1 SPECIAL PERMIT-Approved beFivai ktnpec:ion By +f -' __ Orle Character of Soil to _—___ iusump Soil Character: <br /> CO ENTS r� •� -- ------ -- ---- -, <br /> PE SC Received Check#/ AmountData ParmlV Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> 211) It 7 �- 13 2 3-7-Ib Rou-T,,1 G <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />