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Idly ` 'J : <br /> ONSITE WASSTEWATER"WATMENT SYSTEM PERMIT <br /> .JOAQ0U1N COUNTY ENVIRONMENTA I.HEALTH DEPARTMENT 304 E WEBER AYE-3'"Fl,-STOCKTON CA 95202 v4ql1t)468-3420 <br /> ON-REFUNDABLE PERMIT CALL 209 95i-7697 FOR INSPECTION'S EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS L C1rvlZiP �,. <br /> CROSS STREET APN �4 -1-Z > <br /> G-7 't,(i PARCEI.SIRE : -S <br /> 0 <br /> `L� Q t {' 3 1 -Z <br /> OWNER NAME 1 <br /> �j' ,.� 7\ �+<4--, <br /> r�+U v� PHONE�} .7 - 1 <br /> OWNER ADDRFcn i c G '7��'7 S V,"�- Cm,/STATE1Z1P l C� t D' T� <br /> CONPRAf-tolt 1Atl"!IlE- PIIi1Nk: <br /> t,C: <br /> CONTRACTOR ADDRERS __ _ C1TYISTA1EIZIP <br /> u <br /> LICENSE ❑C-42 Ll C•-36 OTHER NUMBER EXPIRATION DATE 1p <br /> WATER TAm..DEPTH: n GEOCRAPHICALINFORMATION: Coordinates X <br /> ❑ PERCTEST # BUILDING PERMIT LAND USE APPLICATION#Ir A' <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR1AIkDITION 13 ENGINEER DESIGN}.D lALTERNATIYE <br /> ❑ REPLACEMENT ❑ DESTRUCTION I. <br /> M <br /> INSTALLATION WILLRERVE: ❑ RESIDE.NI-v ❑ CONIMERCIAI, ❑ OFIIER <br /> N UMam(IF LfyiN(:UNi rs: N(IMnF.R dF HEDIt oma: N(i MOUS OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPIc1MFG CAPACITY gal #OF COMPARTMENTS r <br /> ❑ GRFASE TRAP TYPLIMI.(; CAPACITY gal #Or COMPARTMENTS s <br /> ❑ PKC.TX PLANT DLSTANCET'ONEAREST: WELL U FOUNDATION 0 PROPERTY LINE n s <br /> ❑ LIFT STATION SIZE TYPEOrPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl f <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE fl <br /> ❑ FILTER RED W InTll n LENG'fll fl DLPTH fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE n <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION li PROPERTY LINE <br /> ❑ SUMPS WIDTH R LENGTH fl DEPTH n T <br /> DISTANCE TO NEAREST WELL n FOUNDATION fl PROPERTY LINE It <br /> Q DISPOSAL PONDS WIDTH fl LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION A PROPERTY LINE n <br /> ❑ SEEPAGE PITS NUMBER WIDTIt It DEPTH H <br /> DISTAN(-F TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE n <br /> I HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NO I_ J'CE REQUIRIED FOR INSPECTIONS-PLEASE CALL.1204)453-7697 <br /> SIGNED TITLE DATE'2— <br /> K mea „ <br /> ya �V <br /> ZN U <br /> N <br /> � »n0•I Qrrrl.a <br /> rl-aGa-tlKT ,OE'CC � <br /> ¢n �Ntl0.} ,2k'Cax 1 <br /> ♦f-ASS-Or: 1 's <br /> WNNHJ Q •�rt.. <br /> 330dfi - <br /> I1J '� ''a <br /> cs-ovo-a.z � � <br /> 31-OPO-aYL ���3v OS' - ra <br /> ENI <br /> Is/T Z7 ;mai arerua ••L.. 3Jlftra_ r x <br /> It-CGO-k�'G WW <br /> ut CK <br /> N not <br /> a3aln5. I �7 71TO y'pd_ � <br /> al-voo-e.r m-61 W 3� v <br /> S u wIS IJOQ"IR 7,y AL <br /> v � V <br /> ,Oi I.I 4 m <br /> YSr SNJGMl3n ou <br /> �4 ng i.4 E sC bix-:cz ---'"---- <br /> nII -- I -- <br /> DEPARTMENT USE OfLN. _} <br /> Application A -�'"-�— Dale_2. o f -� Arca •-•Z f�' Employee 1D F5,f y <br /> Finsl Inspect' �st�!' ❑ SPECIAL PERMIT-Approved by <br /> Character of Sall to Dept a 3 F(: ~�� "''� c9" PItlSump Sell Charactgr: ' <br /> COMMENTS >�i <br /> PE SC Received 'heck# Aknouot Permitf Invoice# Pcrmil ID# <br /> Code INsd B• Cash Remitted Dat Service R uest# <br /> '2412-(1(11 ONSITE WASTEWATER PERMIT <br />