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Vol <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1808 E.HA (-TON AVENUE-STOCKTON CA 9S205-)209)488-5620 <br /> NON-REFUNDABL�YE,PERMIT CALL 209 9 -7697 FOR INSPECTIONS // EJEPIRES 1 YEAE FIKOM DATE ISSUED <br /> JOBADORESS SJw V CITY/ZIP F� <br /> CROSS STREET-4ceg <br /> J� APN If I170 PARCEL SIZE <br /> OWNER NAMEJr ✓(L ✓ PNONE ���� � <br /> OWNER ADDRESS J CITYISTATEMPPJn <br /> CONTRACTOR �6G /. / 5 JLI/ JAl �,c - PHONE <br /> CONTRACTOA�/RADDRE59 ZM2 2-7. /"/- 'GNI {^h //�CRYISTATEMP <br /> LICENSE le C42 iJ C-36 OTHER NUMBER �o'7O.AIIPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICALINFORMATION: Coordinates X Y <br /> PERC TEST % BUILDING PERMIT#IDEaanjgLAND USE APPLICATION# <br /> TYPE OF WORK NEW INSTALLATIONS 4 REPAIP/ADDITION ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL S ERVE: ".! RE91DENCE I COMMERCIAL •TT OTHER <br /> NUMBER OPENING UNITS: jjNUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> _i SEPTIC TANK TYPEIMFG L— CAPACITY /.h�L� gal #OF COMPARTMENTS L� <br /> Cl GREASETRAP TYPE/MFG CAPACITY Dal #OFCOMPARTMENTS <br /> DISTANCETONEAREST: WELL ru21- ft FOUNuATION z It PROPERTY LINE� 8 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS %OF LWE9 2— LENGTH OF LINES yo it <br /> DISTANCE TO NEAREST WELL_ N FOUNDATION�b J-L R PROPERTYUNE �/ �I it <br /> Cl FILTER BED WIoTH R LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL N FOUNDATION R PROPERTY UNE it <br /> ❑ MOUNDED Now R LENGTH it DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION K PROPERTY LINE it <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION 1t PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W DYN It LENGTH it DEPTH it <br /> nt DISTANCE TO NEAREST WELL ROI <br /> FSIDATION R PROPERTY UNE R <br /> �J SEEPAGE PITS NUMBER 1 YNon1 3 K DEPTH"�S R <br /> I DISTANCE TO NEAREST WELL S'O it FOUNDATION it PROPERTY LINE 4 ,T it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK yMLL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. l <br /> MINI 24 HOU DV CE NOT E REQUIRED FOR INSPECTIONS-PLEASE CAL (20�� 769 <br /> SIGNED S <br /> t <br /> zx <br /> I Ful <br /> DEPARTMENTIUS9 RN <br /> Application A«opted - Date 10 1 Z tV I' Area O 4 Employee ID# I-`!✓A� <br /> Final inspection Dated ZAV Jr IJ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: PWSump Soil Character: <br /> COMMENTS Jit..,, L'. <br /> PE SC Received CMek!%•�AmouM bee PermW Involu% ParmK NB <br /> Cade IMP. B Cash Remitted, Service Re uesl% <br /> t I I 14 r IA61 <br />