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I <br /> r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JIVE WEBE.AVE-Y°PL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABL PERMIT CALL 309 953-7697 FOR INSPECTIONS EXPIRES I YEAR mom DATE IssUED <br /> JOBADORYAti 1 O CMID, 1n0 t1 VMr- Z' _ <br /> CROBB 6TReeT pP-�i�11-(/Y-v� . APN Oil � PP..CELSIE <br /> OWNERNAME tm;ro-c—'NPONeJA' "-4Z <br /> Z"� C'k7.40 <br /> 1I' �Iqq � <br /> OWNERADDERNE L�-`�' �.-l1iY y..�PJ�� Crrv/STATTILP <br /> CONTRACTOR O PNOHE �- I <br /> CONTRACTURADDRESS CMISTATFJZIP I IV <br /> LICENSE ❑C42 ❑C-36 OTHEA NUMBER EXPIRATHIM DAM <br /> ®WATER TABLE DEPTH: ft GEOCRAPHICALINPORMATION: CmIdi.MN % y <br /> 7J PERC TEST # BUILDING PERMIT# LAND USE APPLICATIONR <br /> TYPE OF WORK: O NEWINSTALWTIDN ❑ REPAIR/ADDITION ❑ ENGINEER DPRIONED/ALTERNATIVE <br /> ❑ REPLACIEMENT ❑ DESTAULTION <br /> INSTALLATION WILL SERVE: ❑ RE6IDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVINCQNFD: NUMBEROPBEDROOMS: NUMBEROPEMPLOYEE9: _ <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gel #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFO CAPACFTY gel #OF COMPARTMENTS <br /> ❑ PEG TX PLANT DIFTANCETONGRFST: WELLIf FOUNDATION B PROPERTY LINE ft <br /> ❑ LIFT STATION SIIE Tv"OPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLFNES LENGTH OF LIRES ft O <br /> DIVANCCTONEARFBT WELL R FOUNDATION It PROPERTYLME ft <br /> ❑ FILTER BED Wlmx fl {ENGEN R DEPTH ft i <br /> DIWANCETONEARPBT WELLR FOUNDATION R PROPERTY LME ft <br /> ❑ MOUNDED WIDTH_ft LENGTH fl DEPTH R r�rs <br /> D16TANCETONCARPAT WELL ft FOUNDATON fl PROPERTY LIFE R pF. <br /> ❑ SUMPS Wmm R LENGTH ft DEPTH It NNd <br /> DISTANCETONIAREST WELL—11 FOUNDATION a PROPERTY LME ft A,JN <br /> ❑ DISPOSAL FONDS W. R LENGTH ft DEPTH It f� <br /> DIEI'ANCETONEAREFT WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER Wm'tH fl DEPTH ft }( <br /> DISTANCETONEAREST WEIL R FOUNDATION R PROPERTYLME ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OP BAN JOAQUIN COI.ROV. <br /> MINIMUM 24 HOURADYANCE MOTILE REQUIRED FOR INSPECTION'S-PLEASE CALL L209103-707 "1 <br /> SIGNED - — TITLErv.w + �y DATE 0 <br /> IN <br /> SA <br /> I <br /> I <br /> I , I <br /> I I — <br /> � <br /> I e - <br /> i <br /> .- J/.DE ARTMENT EONV <br /> AppLiCeOon AcmphNTt. l��i�l< <_.__.G/�,�Deta - 7GU� Arm Employx lDlt i" I /'���1 <br /> Most lnSWIlOn By DRte ❑ SPECIAL PERMIT-Approved by <br /> Chamfer of Sall to Depth ot3 Pt: DI/Semp Sell C6Rnehr. <br /> COMMENTS <br /> PE6C Realood! by Anoent Permit/ <br /> Doh IOAvhe# PerM[IDp <br /> Code INPO B Tub RemIBW SerWceR Ded#-2 <br /> 4212-BVI ONSITE WASTEWATER PERMIT <br /> y 12R2/LOm <br />