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200 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS F EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRE89 __.aJ � M)(",\kCQCITY21v_ LJ.1 -{� <br /> �Z �,. 1r, <br /> CROSS STREET X71 —___ ___._ APN�L_�1ARCEL S¢E 01 <br /> OWNER NAME PHONE NIS s <br /> OWNER ADDRESS SAhF AS 621 ✓C ___/__'_\-'__'.__._1.�Cm/STaTEIGP ___... '• <br /> -77 <br /> COIITRACTOH � [JAS-f �YYULN(JEI W�.__L�,y SZ/U PHONE <br /> {\ � I/ 1k? Z/�Z <br /> COACTOR ADDRESS CITY/STATE/ZIP <br /> 5O_ y <br /> LICENSE i;C42 OHER__ _. NVMBER_CCSif 9 <br /> __EXPIRATION DATE___2,�y <br /> WATER TABLE DEPTH:_ __N GEOGRAPHICAL WFORNATION: COardlnatos X---- Y.___. .__. IP <br /> Ll PERC TEST M BUILDING PERMIT#_. P?C' _ LAND USE APPLICATION#_ _ <br /> TYPE OF WORK: NEW INSTALLATION X flEPMR/ADORION EN WER DESIGHEp IALTEPNA 3 <br /> REPLACEMENT OUT-OFSERVICESEPTK:SYSTEM DESTRUCTION T <br /> INSTALLATION WILL SEflVE: ✓xRE61DENCE J COMMERCIAL '_i OTHER 0 <br /> i�r NUMBER OF WmG UNDB: NUMBER OF BEDROOM6: _ NUMeEROFEMPLOYEES: p <br /> 1w SEPTICTANK TYPE/MFG "^ CAPACITY Zoe -__ gal NOFCOMPARTMENTS 2 U <br /> ❑ GREASETRAP TYPE/MFG CAPACITY9W #OFCOMPARTMENTS___ r <br /> DMTANCETONEAREST: WELL R FOUNDATM N PROPERTYLm it d <br /> ❑ LIFT STATION SIZE ---TYPE OF PUMP___ O PIGS TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) 0 <br /> TA— ___ - - . .___-__ _---­ N <br /> ❑ LEACH LINES X LEACHING CHAMBERS__L A->I-g #OFLMES,,�cc3 _ LENGTHOFLINES FaCO'_� IT <br /> DISTANCE TO NEAREST WELL-_I�___ R FOUNDATION-__it PROPERTY LINE.� +s it <br /> ❑ FILTER BED WIDTH_ ft .LENGTH,-. .... _—_ It DEPTH ___ft <br /> DISTANCE TO NEAREST WELL_____. i1 FOUNDATION -__ft PROPERTYLINE IT <br /> ❑ MOUNDED WIDTH K LENGTH R DEPTH 4 <br /> DISTANCE TO NEAREST WELL___ R FOUNOATION ft PROPERTYUNE If <br /> C} SUMPS WIDTH 'C _-_ _K LENGTH.__SS—____ R DEPTH \O ft <br /> DSTANCE TO NEAREST WELL_J40�_—__.. it FOUNDATION -_____ft PROPERTY���LLLLINESLS it <br /> ❑ DISPOSAL PONDS WIDTH _It LENGTH If DEPTH �it <br /> DISTANCE TO NEAREST WELLR FOUNDATIONB PROPW 11/tom ft <br /> ❑ SEEPAGE PITS NUMBER—- WIDTH If LL ft DEPTH__��(�j"(�j ft <br /> DISTANCE TO NEAREST WEILL— FOUNDATIONII PROPERTYLINE�_ Zyy� it <br /> I HEREBY CERDFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN GNCDOANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. HEALTH DEP ENTAL <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091 <br /> SIGNED _ _-----_______-. TIME. ItS)OEM DATEb <br /> 3 t <br /> i <br /> I <br /> Application Accepted By -Lj—_ Oate ,-- { Area a` Employee lD# ��� <br /> Final Inspection By DateSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: _._ PIVSump Soil Character: <br /> COMMENTS 6" A 9A4.AL DrT-.wVf Lo--s�-+H/(�+ + .+o E-✓� S!�-Lsl.t S.�Lt; !6P <br /> PEBC Received Ch¢ek Amount Data PmmW Invoke# PermK lD# <br /> Code INFO B ash Rem llteQ� SerAm R ueet# <br /> 24 1t"S <br /> I <br /> 4201 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> AnarP <br />