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LONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3p*FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIO%S EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOSADDRESS //3S/ F �nl.nw 1j,- m <br /> clrr/ZIP n r n <br /> LCROSS STREET S/1aX.CzAPN e)0-7 1 C PARCEL SIZE 10 Ci(S�feS O <br /> OWNERNAME ySSHI/2F.�/ PHONE ZC.iF- SJ(,r <br /> L OWNERADDRESS CITYISTATFJZIP <br /> CONTRACTOR LGIf/ 1/f,U 4+/J�G PHONEsl-�CJZ7 <br /> T <br /> CONTRACTORADDRESS .ZZ'&i F " ,GAN/<Lf !A!!C CTTV/STATE/ZIP 4ez <br /> L LICENSE PLC42 (3 C-36 OTHER NUMBER E%PIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y `Q <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION k v <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIWADDITION L1ENGINEER DESIGNED/ALTERNATIVE <br /> L REPLACEME13ElN ❑ DESTRUCTION <br /> INSTALLATION E: RESIDENCE COMMERCIAL OTHER <br /> A-/ NUMBE0.0P LIVING UNITE: <br /> WILL SERVNUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> Ib SEPTIC TANK TYPE/MFG CAPACITY 11,60 Bal R OF COMPARTMENTS737 <br /> _ <br /> L ❑ GREASE TRAP TYPVMFG CAPACITY gel N OFCOMPARTMENTS <br /> ❑ PEG TX PLANT DISTANCETO NEAREST: WELL SO" ft FOUNDATION 7' R PROPERTY LINE /lXJ✓- ft <br /> ❑ LIFT STATION SITE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LLEACH LINES ❑ LEACHING CHAMBERS q Of LINES LENGTH OF LINES <br /> DISTANCETONEAREST WELL /S R FOUNDATION PROPERTY LINE <br /> ❑ FILTER BED WTON ft LENGTH ft DEPTH A <br /> L DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH ft <br /> DISfANCETONEARBSr WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> (� DIWANCETONEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> Iq SEEPAGE PITS WIDTH "" It LErvcrx fl DEPTH aSl ft <br /> DmANCETONEAREST WELL IId R FOUNDATION 3O ft PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE INACCORDANCE WITH SAN JOAQUIN 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)953-7697 <br /> k SIGNED TITLE �^s>!� DATE w/z <br /> LI Ir <br /> O / -� <br /> 1� <br /> I Pal <br /> L <br /> 4- <br /> ut, Ggal ---H <br /> 5 <br /> L Bl H NLHO <br /> N <br /> L <br /> DEPARTMENT USE ONLY �� !I'nq <br /> Application Accepted Dale 6� Area: � Employee lDM 7 <br /> -I V{ <br /> Flnalinspectlo Y X19 Date /n//fi/pm 3 ❑ SPECIAL PERMIT-Ap mvcd by <br /> Chafvcterof Depth T3 Ft: mt/sump Soll Character: <br /> COMMENTS <br /> 0 <br /> 1 <br /> 4 PE SC Rerelvetl ChAmount PermiU <br /> Code INro 6 ash Remlttetl Date Servire Request# Invoirep Permit lDM <br /> L ✓ <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> 12 LX <br />