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ONSITE WASTEWATEI- "REATMENT SYSTEM PERMIT <br /> 6.3AN JOAQUIN COUNTY EN `VIRONMENTAL HEALTH DEPARTMENT `o" 304E WEBER AVE-3YO FL-STOCKTON CA 952014,019)46H3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESE -I CITY/ZIP (-InIr <br /> CROSSSTREET All f- PARCELSHE p <br /> OWNER NAME �1/.�I(_F ( I Y/'' /V�I.Ll l y�_ry1J �/n�+1 (�P/NONE /� l� <br /> OWNERADDRESS CJI\J✓ �• GE I'V711 l I a-ri CLIV/STATVZIP /' Yl t1VYr���l�lJ CA , <br /> CONTRACTOR ` PNONE <br /> i and �l <br /> CONTRACFORADDRE59 if . I CITY/STATE/ZIP i( I <br /> LICENSE L3 C-42 ❑C-}6 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGIGPHICALINFORMATION: CoarAiDafer X Y (� <br /> J.� PERC TEST # RUILDINGPERMIT# LAND USEAPPLICATION#Il'J6L P- :I•-0lii( 1 \" <br /> TYPE OF WORK: ❑ NEW INRTAIA.ATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE �j <br /> ❑ REPWCEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NuBDHROPLIVINGUNTTE: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> -❑ SEPTIC TANK TYPFJMFG CAPACITY gel #OF COMPARTMENTS `� <br /> y❑, GREASE TRAP TVPE/MFG CAPACITY gel #OFCOMPARTMENTS <br /> U PKG TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl_! <br /> ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINEs LENGTH OFLINES fl J <br /> DISANCETONEARF_1T WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH fl <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE fl <br /> _,❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTB R LENGTH ft DEPTH R <br /> DISTANCETONEARFST WELL ft FOUNDATION fl PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> ana DISTANCETONEAREST WELL ft FOUNDATION A PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DRUANCETO NEAREST WELL R FOUNDATION H PROPERTY LINE R <br /> I• I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE GONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> /., ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> UMLHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED � -CC41i` TTI'CE �( G"�/ i' ':./� DATE <br /> Ban, rr <br /> q <br /> ' ' 4 <br /> U N NTT <br /> B 4 O ENT <br /> i <br /> �' �AAR�TMFNT USEJ9NLVV Applicatn AceepRd By 0' I / Area a, a- Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil tD Depth�of 3 pt PH/Sump Soil Chanchr. / <br /> COMMENTS Lde 71!; r e.d. �I dr <br /> PE SC Rec.Wed Chmli Anlouxt Date "arm <br /> " Invoitt# Permi[IDp <br /> Code Inco ��l Rend= 11 C Servke R,uat# <br /> Y <br /> �IA2U3-0BI ONSITE WASTEWATER PERMIT <br /> IJRIr2901 <br />