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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46$3420 <br /> NON-REFUNDABLE PERMIT �. CALL(209)953-7647 FOR INSPECTIONS EXPIRES 1 YEAR fR0_rM DATE ISSUED <br /> Joe ADDRESS � r+�tA.• j'Lli� CITY/ZIP—Ail <br /> CROSSSTREET to t L:'Yt� APN 16 3 S'� PARCEL SIZE_ <br /> �O <br /> -- � <br /> OWNER NAME � i1 H nJ1� �I'*I� PHONE <br /> OWNER ADDRESS ,%�'�'P �f CITYISTATE/ZIP <br /> fJ c tom-- I <br /> CONTRACTOR ty/�(L.cS ACIckC �-Q c�Lr6 PHONE_-�,^^+} ] ,,y� <br /> CONTRACTOR ADDRESS j� n f4^-'}V, V.�(� �� '�(� CITY/STATE/ZIP'/ 1 f'i'�.�L^ � �'/a f7S I <br /> LICENSE I.C42 ,C-36 OTHER 44"`. NUMBER 106 35 gEXPIRATION DATES �U <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST III PERMIT#,. —_LAND USE APPLICATION <br /> TYPE Of WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED IALTERNAnvE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: i;K.-IDENCE COMMERCIAL OTHER 1 <br /> i <br /> 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: _J <br /> ❑ SEPTIC TANK TYPE%MFc— /LT 7/y CAPACITY— gal #OF CO"PARTnaENTS <br /> ❑ GREASETRAP TYPE.IMFG - CAPACITY _ gal #OFCO&IPARTMENTS, -___ { <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE fi i <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SAN7ENGTH <br /> LSEPARATOR(E OSED YSTEM) <br /> LEACHUNES LEACHING CHAMBERS #oF NEs LINES <br /> DISTANCE To NEAREST WELL_�yti" ft FOUNOATI N_ f it PROPERTY UNE <br /> ❑ FILTERSED WOTH __ it LENGTH Y DEPTH __T7zT It i <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE — It i <br /> ❑ MOUNDED WIDTH It LENGTH It DEPTH__ <br /> DISTANCE To NEAREST WELL. it FOUNDATION fl PROPERTY LINE It <br /> ❑ SUMPS WIDTH fl LENGTH ft DEPTH —It ! A� <br /> DISTANCE TO NEAREST WELL fl FOUNDATION _fi PROPERTY UNE It Y <br /> ❑ DISPOSAL PONDS WIDTH.-_ _-------_-.._.ft LENGTH_- ------_--_.—,__R DEPTHit Ai? <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE it I ,J{�•�`` <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYUNE $A A. It 120, <br /> I-HEREBY CERTIFY THAT I HAVE PREPARED^THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH;AW;. COUNTY ORDIII,p,L1C[ Vi�y(f'N <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. F� <br /> MININAUM 4 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 �/.rH rJ� )gUNTy <br /> [� <br /> SIGNED .LL TITLE IJL �ri'r(�<fg—� DATE r"S A�TM�jyT <br /> 1 <br /> T1 J <br /> I 1 <br /> DEPARTMENT SEF N Y <br /> Application Accept / Ltate�� I — Area �4- EmployeeID#__ '� <br /> Final Inspection By _.�4A o- _ Date��?tt _ SPECIAL PERMIT-Approved Ly <br /> Character of Soil to Depth of 3 Ft: PI ump Soil Character: <br /> COMMENTS f Cc.- <br /> PE SC Received Amount Date P IU Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />