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ONSITE�ASTEWATER TREATMENT SYSTEF^,ERMIT <br /> SAN-IDAQUIN COUNTY ENVIRONMENTAL _Tf DEPARTMENT 606 E MAIN S. f-STOCKTON CA 95202-(209) <br /> NON-REFUNDABLE PERMIT �r CALL�-(7209)95$-7597 FOR INSPECTIONS EXPIRES S YEAR FR '�.TE u <br /> Jos AiDDRESa oC V S K G„S�C•11 {l CITYIZIFFly <br /> CROSS STREET l'{orvr� :S CC.�1 APN 3ci -Q PARCELS¢£ ! <br /> OWNER NAME -1 i �� L'F1 V PHONE <br /> w <br /> u <br /> OWNERADDRESS CITYISTATE2IP <br /> CONTRACTOR &N ecf;-yc rl 6 Xec� I.'z._I-iYtel PHONE 2,54- 3,) I 'ram s` <br /> CONTRACTOR ADDRESS ,�� / 7 f�Ce� CIT ISTATEfZIP (`P -C11 C e- <br /> LICENSE EC-42 ❑C-36 OTHER � NUMBER � I Jd.ExPIRATKm DATE -,7-- <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # $UILDING PERMFT# -OF-PC-L5 " LAND USE APPLICATION 9 <br /> TYPE OF WORK: NEW INSTALLATION 7 REPAWADDmoH 7 ENGINEER Desimo IALTaRNATIYE <br /> I- REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: 131z'RESIDENCE 0 COMMERCIAL f ER <br /> NUMBER OF Lmima UNITS: NUMBER OF BEDROOMS: AUMSFLR OF EMPLOYEES: <br /> � SEPTIC TANK TYPElMFGCAPACITY JOU gal #OFCOMPARrMENrsT <br /> LJ GREASE TRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DIATANCETONEARPST; WELL ft FOUNDATION It PROPERTY LINE ft <br /> O LIFTSTATION SIZE TYPE OF PUMP O PKG TX PLANT SAND OIL SEPARATOR(EN, SYSTEM) <br /> i 1~*' <br /> L1 LEACH LINES LI LEACHING CHAMBERS #OF.VINES LENGTH OFLIHES t<la ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it- PROPERTY LINE ft <br /> O FILTERBED WIDTH ft LENGTH K DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> E3 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 11 SUMPS WIDTH It LENGTH ft DEPTH Ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It V, <br /> C1 DISPOSAL PONDS WIDTHft LENGTH ft DEPTH ft r, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Z <br /> D SEEPAGE PITS NUMnER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft. PROPERTY LINE }) <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> -IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> p SIGNED_ ��_ rl�# r�a� +_ <br /> ' to m m <br /> ` 1 L) <br /> � w <br /> n LD f �= �_ - RECEIAYW SANJOAflUENHFAI DEPAL <br /> FNVIRONM <br /> mss,.�r.�.> �r S ' <br /> Application Accepted B �---- Date I Area Employee Ip# <br /> Final Inspection By Data - _ SPECIAL PERMIT-Approved by <br /> h' Character of Boll to Depth of 3 Ft: R t/Sump Soil Character: { <br /> "COMMENTS Cf-0 c vT &F /1 <br /> PE SC Racelved ChecW Amount Permit/ <br /> Code INFO By Remitted Date Service Re uest# Invoice# P"q ID# <br /> t 2IfS {FS+�•LZi S 1 <br /> K <br /> 42-Dl ONSITE WASTEWATER TRYL SYSTEM PERMIT <br /> M4l07 <br />