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.a.�t t Q vvr o 1 CVYA 1 CR 1 RCA I111 1 ATJ I tM F'tKM1I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4G"420 <br /> NON-REFUNDABLE PERMIT CALL 2O9 8$3-7687 FOR INSPECTIONS EXPIRES'I YEAR FIRCIMIXTE ISSUED <br /> JOBADDRESS 7-+41 -S Al -Maw nT <br /> P£ /w• CITY2IP jiiroR-,4"P-I a <br /> CROSS STREET IJOtJ ELL APN 00(-2-ID-3315-0A"C <br /> g <br /> PARCELSIZE <br /> OWNERNAME AL CCJI - T>AvL%FPrc.(• F-q, .n.LPHONE 'Ma- zS'-Y-6P�-40fP <br /> ^ �n <br /> . OWNERADDRESS. P-0• a" ID •�Q CITYISTATEZP Ir�MR/J•TD�� � (+�6�0 <br /> CONTRACTOR LWe7 (D1A-V-_�j-EOE�N{IZ011l wl /./'T{�L PHONE Z-01-3661-0345'- <br /> CONTRACTOR ADDRESS 1/J- C)hK STI CL0D(J CIO,, R•ri�-F.0 <br /> RY/STATE21P <br /> LICENSE CIC-42 QC-36 OTHER NUMBER EXPIRATONDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: C001dIREteS X Y <br /> 1� PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION# PA--I fD 0 L5-(7-- <br /> I <br /> S(P <br /> TYPE OF WORK: ❑ IMMINSTAD-ATION ❑ REPAIWADDITION 0 ENOWEERDESIGNEDIALTERNATIVE <br /> 0 REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTTER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEMHFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL IT FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP ❑ PKGTXPLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS 0O LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERBED WIDTH It LENGTH ft DEPTH IT <br /> DISTANCETONEAREBT WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS (MOTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERWUNE ft <br /> ❑ DISPOSALPONDS WImX ft LENOTH ft DEPTH R <br /> DISTANCE TO NEAREST V.ELL ft FOUNDATION ft PROPERTY LINE IT <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> • 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOA0UIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUy.2p HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209)9S3-7697 <br /> SIGNED �Ci/cam TITLE C6NSt7LI-1 JT- DATE I-P-1l <br /> v <br /> i . . I RI �• `� _;— .I� <br /> ITT <br /> ev Peru �tA B PZ <br /> 7I I <br /> PAYMENT <br /> 8 2018 <br /> dOAQUINCOUN71' <br /> _ IROly,L1 <br /> DEPARTMEM SE O LY <br /> ApPliwUon Accepted B to D Area Employee ID# I/I/DU167 MENTI <br /> Final Inspection By Data ❑ SPECIAL P IT-Approved by <br /> Chafaeter of Soil to Depth of 3 Fk PlIUSUmP Soil Character. <br /> COMMENTS <br /> NIB <br /> • PE gC ReceivedChet Amount DBMS PermiU Invoice Permit DO <br /> Code INFO ash RemiServiee Re ueat# <br /> S tfb 10 I S&LO 961 <br /> a2-01. ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />