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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SOO E MAIN STREET-STOCKTON CA 9$202-(203)468+3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CIrvT[IP n -4 9536jF >� <br /> • CROSS STREET GC/-{A17'AA _APN Z-OS— D7�0—IFL� PARCELSPE lO y <br /> OWNERNAME :10IIA 144 MPS PHONE <br /> OWNERAODRESS SaW � CRYISTATEIL)P <br /> (^� <br /> CONTRACTOR V✓11,I/L�CTS rsuG41L is 4r, PHONE Ho[���—{��L.S� ..G p •J.�/ <br /> CONTRACTOR ADDRESS _0/r�_�oX `[oS�A Cmy/F <br /> /STATE21P E+F) ,4 <br /> LICENSE QC42 �:C-36 OTHER_ NUMSER nsMF-PIRATIOd DATE Zoo.. <br /> WATER TABLE DEPTH: A GEOGRAPHMALINFOR ATKIN: COOrdinaws X Y <br /> ❑ PERC TEST N :BUILDINGPERMIT# _ ! �ANDUSEAPP❑CATION# <br /> TYPE OF WORK: NEWINSTALLAIRON D REPAIRIADOITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ Our-OFSERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑:RE%DENcE ❑ COMMERCIAL OTHER <br /> •� <br /> / NUMSER OF LMNG UNRS: _ NUMSEROFBEOROOMW NUMBEROFEMPLOYEES: - <br /> VSEPTICTANK TWEIMFG '��L.� <br /> CMAC g2I N OF COMPARTMENTS r <br /> ❑ GREASETRAP TYPFJMFG CMAC gal SOF COMPARTMENTS .J <br /> DISTANCE TO NEAREST: WELL ipoqL It FOUNDATION IDI it PROPERTYLINE LSI R <br /> ❑ ❑FTSTATION SIZE TYPEOF PUMP O PKGTXPLANT O SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> Wl'LEACHI LINES ❑ LEACHING CHAMBERS #WUMS �._ LENGTHOFUNES (00I ft <br /> DWTANCETONEAREST WEIR JQ44' It FOUNDATION Il,l R PROPERTYLINE 7St ft <br /> ❑ FILTERBED mm ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE a <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH R <br /> DI <br /> �/ WSTANCETONEARUN <br /> EBT WFEL ft FOUNDATION It PROPERTY LINE ft <br /> V JUMPS DTH a. It LENGTH ISI • It DEPTH IQr R m <br /> DISTANCE TO NEAREST WELL�1004- ft FOUNDATION IDE R PROPERTYUNE �I.�i 'R�• yYA•, <br /> ❑ DISPOSAL PONOS WIDTH ft LEKiTH R DEPTH R <br /> • DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGEPITS NVMSER W COI ft DEWH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYUNE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED T1-1I3 APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. n <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CAL 209 953-7697 <br /> SIGNED TITLE/S.Af(eu/•r DATE to $ it <br /> I <br /> I <br /> N <br /> E <br /> gaw <br /> 0 M <br /> H <br /> I <br /> DEP TMENT E NL <br /> �L a•_-.�Applloa6an•Accspled BY -- •=.DaW.— _ -.—.Arae. .. =Sr.Plorio-IDN7 <br /> Final I.Pection BY Date - ❑ SPECIAL PERMIT-Approved DY <br /> Chamdar of Soli tO til of 3 Ft 1plulfump soil Character. <br /> COMM NTS <br /> I tea. <br /> a <br /> PE SC Received Chec AMOUnt ParmW <br /> Cod• INFD Remifted Data ServlDOR uest# Imrolutl Permit lDN/ S <br /> • IFitl U l lP2% 'f73•cD (P N .S oolP2 <br /> ..yNlti <br /> 4241 ONST[E WASTEWATERTRTMNT SYSTIEM PERMRJ�"" <br /> 9f21110 ti <br />