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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOADUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAMILTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT .M{(" CALL 209 953.7697 FOR INSPECTIONS <br /> �� �ExPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS LT L�i._...__.J.-l/S.ItTfL__Ar' _-CrTrap /�M� 1 4l . ; - <br /> DRoss StnEET - A•/�'L.__dC]13.: APN._ �.(. O19to _._PARCEL SUES <br /> OWNER NAM NAME 1 'l/NO"1 �aN'✓}_ / 7(L SI____. PNONE_ � 'V f���� Y <br /> OWNERADPREBE . __ __.______CRLYBfATEJ ^P <br /> CONTRACTOR Ufty G�A(6AFAA t/7L✓'YfM^C-t�Or� <br /> CONTRACTOR ADDRESS, _ l�U I _�Aili MJ[_ .. .._CMMTATE/LN <br /> LICENSE ';C.42 %;C45IC4e OTREEF,,ft EA-U u NUMBER�____^�L_I_EMPPATION DATE I T _ __.-__ <br /> WATER TABLE DEPTN:.__!___-_.. It GEOORAPHICALINFORMATION: Coordinallaa K__.__ Y <br /> PERC TEST a_ _.. BUILDING PERMIT R_ _. LAND USE APPLICATION• <br /> TYPE OF WORK: NEWINBTALUTKIN REPMRIADORNIN Eaawaim DEstuAl ALTEA NAIVE <br /> REPLACEMENT __._ _—_ GUT.OF-BEARI SEPTIC SYSTEM DESTRUCTgN fiZ <br /> INSTALLATION WILL SERVE: RESIDENCE COMYERCILL OTHER <br /> NVMaEA OF LNNa UNim _ NUMeER OF BEDROOMS: ___ _ _ NUMBER OE EMPLOYFJDT: <br /> U SEPTIC TANK Tv E/MFG ... _- CAPACITY gal NOFCOMPARTMENTS______ <br /> U GREASETRAP TYPE/MFG _-. ___ CAPACDY __....__— gal ROFCOMPARTMENTS___.__ <br /> DRTANLFTONEAREST: WELL R FOUNDATION _ R PROPERTY LME R <br /> 17 UFT STATION SIZE _TYPE OF PUMP--CI PKG Tit PUNT G SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS_ _ _ _ EOFLN&S LENGTHOFLINES ft <br /> DtSTANCETONEAIEST WELL___ R FIXNAATION R PROPERTYLME__ _ R <br /> ❑ FILTER BED WID7H R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R PONOATROI R PHDPERTYLNE __R <br /> U MOUNDED WIDTH R LENGTH R DEPTH R <br /> OISTMICETONEAREST WELL N PCIINDATION R PROPEHTYLINE it <br /> U SUMPS WIDTH _R LENGTH___ R DEPTH _R <br /> DISTANCETONEAum WELL R FOIBIDATION ft PROPERTYLINE R <br /> U DISPOSAL PONDS WIDTH __.__._. —ft LENGTH ft DEPTH _ R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYUNE R <br /> ❑ SEEPAGE PITS NwBER _ WMYN R <br /> DISTANCE TO NEAREST WPLL R FOUNOATION R PROPERTY LINE it <br /> I eEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE N ACCORDANCE YRTH SAH JOAOUIN COUNTY OBONAMCES. <br /> STATE LAWS AND RULES AND REGUUTIONS OF SAN JOAOUN COUNTY. <br /> 4 HOUR ADVANCE N07747a REDOFRED FOR INSPE TIONS-PLEASE CA 3-7 <br /> SIGNED .. =' ._.___ TITLE -- GATE_IL /Yi <br /> RIM <br /> VII I <br /> I= <br /> G N . <br /> N 1 E T <br /> 1t � O PART I <br /> FinalI spe AooeptedB DaM- Area OI I`R EmpWee by t°`S. <br /> Final lna Oona _ Dala.� SPECIAL PERMIT-ApprWeAM <br /> Peo Y <br /> Chereoter o1 Soil to of 3 Ft: PI Sump Solt Charaelar: <br /> COMMENTS <br /> PE SC flxNVMAmounl Uata PertnIV Involp• ParTM11W <br /> Code INFO C Ra hMd Sam ant s <br /> e?-0t ONSITE WASTEWATER TRTMAR SYSTEM PERMIT <br /> ANUI2 <br />