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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMEWAL HEALTH DEPARTMENT INS E.HAZELTON AVENUE-STOCKTONCAOS20S-(209)as&.3M <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> doe ADD,Ess <br /> CROSS STREET WCOOISMJ QiJ_hA APNPARCELSRE _ <br /> OWMER HANE__-�INp � �� <br /> OWNER ADDRESS .LLA___��J�+"__.____.____.____. CfFY/STATFILP --_ _________ •. <br /> coNFRAcroRwG51.GL7AMS.1L.�/jS.�1LDE�/_INL—_�-��.'l��—.._PeroNEq°��y <br /> CONRRACTORADDRESS 1�•=]yiaCt( -!-..__._ _ ____.__. C1IY/STATEZP._�OZ r�L 7 ........ .0 <br /> LICENSE 1,!C-42 IJC-38 OTNEIi._A:_...___— NUMBER.__ II "7EWMTIONDATE------ v <br /> Lor,—_—...._.._ __... V. <br /> WATER TABLE DEPTH: _._._ It GEOORAPH /NFD ATM: Coordinates %�.. Y , <br /> !—PERC TEST # BULLRING PERMIT R__.__..—__ LAND USE APPLICATION N___.____ s <br /> TYPE OF WORK. NEW INSTALLATION LZ REPAIWADOrnom ENGINEERDESIGNEDIALTERNATINE f <br /> REPLACEMENT _.. ._.__.. ....__._ OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTON <br /> INSTALLATION WILL SERVE: `1 RESXI NCOMMERCIAL O OTHER -9 <br /> NUMSERO UVMGUMTS:._--_.—____.. NUMBER OF BEDROOMS: NUMBEROFEMROYEES: <br /> ❑ SEPTIC TANK TYPE/MFG._.__ -__.. __. CAPACITY 9al 0O C(XAPARTMEMS___,-,____ ._ T <br /> ❑ GREASE TRAP TYPENFG .___. .._. __... CAPACITY _. _ gal #OFCOMPARTMENTS___— _. o <br /> DISTANCETO NEAREST: WELL _ It FOUNDATIONN PROPERTYUNE It y <br /> ❑ LIFT STATION SITE .. TYPE OF PUMP _._ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) SSSyyy$``h' <br /> O LEACH LINES VL LEACHING CHAMBERS-_.)^'�r�...�},tA�: #oF LINEs_._ � LENGTH OF LINES_�J <br /> DISTANCE TO NEAREST WELL it FOUNDATION_I;1'4-_tt PROPERTY LINE LOI~....__....N <br /> ❑ FILTER BED Wane It LENGTH N DEPTH_ N <br /> DISTANCETONEAREST WELL It FOUNDATION---ft PROPERtt UNE ..._._-tt <br /> ❑ MOUNDED Wiw" N LENGTH__ N DEPTH N <br /> DISTANCETONEARFST WUL_ _ It FOUNDATION—ft PROPERTY <br /> ❑ SUMPS WwTn___...__._.___„_-N LENGTH--- It DEPTH tt <br /> DISTANCE TO NEAREST WELLit FOUNDATKaItt PROPERTY UNE_ It <br /> ❑ DISPOSAL PONDS WwR________._N LENGTH __It DEPTH - _R <br /> DMTANCE TO NEAREST WELL It FOUNDATIONN PROPERTY LINE <br /> 3` SEEPAGE PITS "WHER _ - Ww!/-T-HS� . N DEPTH LS ..._IT <br /> DISTANCE TO NEAREST WELL It FOUNDATION O r _ .N PROPERTY LME p It <br /> I:iEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS Of SAN JOAQUIN COUNTY. <br /> MINIMUM 24 WUR ADVANCE NOTICE REQUIRED FOR INSPECT/ON -PLEASE CAL(M 953�-�7�697 <br /> SIGNED ._...... _.. _. __ ._ TITLE _.. IGStI ^�I DATE_L-1=a-�I'1 <br /> tg , <br /> - <br /> lr—,_ <br /> o ' NE <br /> r <br /> m jr Ac UI <br /> �. A <br /> _ 1 <br /> OEPA <br /> Application AcceP Date. -V `rea D4�— Employee ID#__,�f�b_� <br /> fMet inspection By Det, 7 ( A SPECIAL PERMIT-AppmYad DY <br /> Character o1 Soll to of 3 FC_ __._. Pwsump Sol]Character: <br /> COMMENTS ll Z_ waFs y' <br /> PEW SC Received �CNh- ---Amoonl Dote PermW InvoleeB Permit IDS <br /> CodINFO B .-Ceah Remitted Service R uest to <br /> 25.1 17 �3•o'J /� lv$Sa� <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />