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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT f/ <br /> SAN JOAQUIN COUNrY ENVIRONMENTAL HEALTH DCPARTMENT 1888E.HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FORINSPECTIONS �EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS O 1 a 1,_. Ove— _._. __. CmMP <br /> CROSS STREET ,/J / ........__.___.. APN_ �03�.-ZfO- Z�- PMCELSD'E_�— e <br /> OWNER NAME /"Reeo Q(r/I���e ee P., 10.9 4t(J.2-.Z71i <br /> //,AT ,I <br /> I <br /> OWNER ADDRESS /O r`-' / 0//O/'M A.,i( CITYISTATEMP <br /> I/a7e$ W4-ir1 p --F <br /> (A]NTRAGTDR_- �.✓4 fcr PHONE Z�7 6?8-��1[[�1-- <br /> CONTRACTO��RAA/DDRESS /O 191Z1940 pO_ CITY/STATTMP DC/16"J',eG S <br /> LICENSE IIMC-42 ❑r C3O_W6 OTHER NUMBER' 11i'dEXPIL NDATE. <br /> WATER TABLE DEPTH:--- D GEOGRAPHICAL INFORMATION: Coordinates X_ Y <br /> I1 PERC TEST t_ T BUILDING PERMITk ( QO J LAND UBE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REGMRIADDITION ENGINEER DESKINEDIALTERNAME <br /> REPLACEMENT OUT-OFSEAVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RSUDENCE I� CmAMEACIAL LI OTHER <br /> NUMBER OF LNINO UNRS: / NUMBER OF BEDROOMS:_ Ar NUMBER OF EMPLOYEES: O <br /> ❑ SEPTICTANK TYPE/MFG T L CAPACITY_��OO gal YOFOOMPARTMENTS L <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal Y OF COMPARTMENTS_ <br /> DISTANCE TO NEAREST: WELL -TIO, _ N FOUNDATION '> I K PROPERTY LINE 'I It <br /> O LIFTSTATION SIZE---TYPE OF PUMP—__._._ O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS YDFLWES 3 LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL.__13a It FOUNDATIChl 7-0- .ft PROPERTY LINE ZAIV ` h <br /> ❑ FILTER BED WIDTH It LENGTH K DEPTH It <br /> DISTANCETONEAREST WELL ft FOUNDAHONI It PROPERTY LINE h <br /> ❑ MOUNDED WIDTH R LENGTH_—_ h DEPTHp 'rl <br /> DISTANCE M NEAREST WELL __R FOUNDATION ft PROPERTYUNE Fi <br /> ❑ SUMPS WIDTH---ft LENGTH h DEPTH y <br /> DISTANCE TO NEAREST WELL _ It FOUNDATI(N .__ft PROPERTYLINE 11-,.?A It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH _ __ft DEPTH It <br /> DISTANCE TO NEAREST WELL__ ft FOUNDATION ft PROPERTY LI I .!'n'IRONL.� Mitt <br /> (Ir SEEPAGE PITS NUMBFA 3 WmIN `/.2 n ft DEPTH D R <br /> DISTANCE TO NEAREST WELL 1.T C <br /> - _ N FOUNDATION PROPERTY LINE -ENO N <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIM Z2 HOINSPECTIONS-PLEASE CALL 2O9 953-7697 <br /> SIGNED UFd <br /> Tint Q✓I[/ Pl � - DATE <br /> Ar. <br /> OEPARTMENT _ <br /> Application Accepted By - (ate -4Area yO�� Employee IDM • Wn <br /> i <br /> Final Inspection By Gll-�°'I _ Dale JwY___._ I] SPECIAL PERMIT-Approval!by <br /> Character of Soil to Depth of 3 Ft: _ Pit/sump Soil Cheraclsr: <br /> COMMENTS <br /> PE SC IR 7d h Amount PMraw Invoice M P"II IDM <br /> Cada INFO B ash MmNlad Servka Request Y <br /> Ali � � t I SRLD678 59 <br /> I <br /> 4201 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5 17 <br />