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ONSITE WASTE --'ATER TREATMENT SYSTE7 - "ERMIT Z Z 70 // <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DENT' 304 E WEBER AN,�FL-STOCKTON CA 95202 - (209)468-341CW <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jou ADDRESS :2V %p2- 1V . 6?wles ✓( CI'n/ZIP {�/� 't <br /> CROSS S'I'KF:F:I' Llli elV/ w 0O C/ /U` APN O 07 '��� V PARCEL SIZE fJ `i��G v <br /> OWNER NAME y J.S e, /� PHONE: y <br /> OWNER ADDRESS AA <br /> � Z�7 Z t'l Al S e w/rG fSyl(� CITY/STATE/Zip y <br /> CoNT'Kn(`t'oK /�j�f:/� ^�J/�ee 1 L ( PHONE: <br /> CDN'1'KA("1'OKnUUItE:ss C� �v /r y�" `� ` CI'r1vSTATk:/ZIP`7•���+kfo� G/�; - �J L�� <br /> LICENSE: ❑C-42 ❑C-36 OI IIER 'S7 NUMBER Y 4 / 2.� � E\PIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 ,4 PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ REsIDENCE ❑ COMMERCIAL. ❑ 01HER <br /> NUMBER OF LIVING UNI"IS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY galOFC PAR N <br /> ElGREASE TRAP TYPE/MFG CAPACITY gal o .S <br /> ❑ PKC TX PLANT DISTANCE T'O NF.ARESI': WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ll <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ti V <br /> DISTANCE TO NEAREST WELL. tt FOUNDATION ft PROPERTY LINE tt <br /> ❑ FILTER BED WIDTH It LENGTTI tt DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE <br /> ❑ MOUNDED Wurru Il I+N6IH Il DI1,111 II f7 <br /> DISI'AN(T'.'rO NLARLST WF.I.I. fl I'OtINDA IION fl PROPLR I Y LIN1.__ _ Il <br /> ❑ SUMPS WIDTH It LENGTH Il DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ It <br /> DISTANCE 1,o NEAREST WELL It FOIINDA'IION _ _ _ h PROPHO Y LINIi _ t1 <br /> El SEEPAGE PITS WIDTH It LLNGrH -- — - _ tl DFI,111 --- It T <br /> DISTANCE-1.0 NEAREST WELL ft FOUNCJAT'ION ft PROPERTY LINE It ,O <br /> I HFRE:BY CF.RT'IFY THAT 1 HAVE;PRb',F E:D THIS APPLICATION AND THE WORK WILL BE:DONE.IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> \-TATE:LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNT). <br /> i <br /> INIMUNI 24 OUR ADVANCE NOTICE REQUIRED FOR IN`SPE T'IQN'-PLIh�SIF:CALL(209)9.3-7697 <br /> SIGNED �./ )�--�'� L TITLE 4),I y i 1r ���!l� DATE L <br /> Q sw.-z <br /> a•a _7 n <br /> n <br /> ) <br /> 0MV"—Tt9 MAINDE0. j J <br /> —YIGIHITYMaA <br /> j-� ►or 1,o KJiL <br /> A UI C U TY <br /> EN IR <br /> JAKWT ROAD <br /> DEPARTMENT SE OE' Y <br /> Application Accept y to 7 ) Area Employee ID# <br /> Final Inspection ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br /> s - <br /> (OMMLNTS � ��_� ,% - -tom`L — nc� �� � e�•e�� �e � ��-� <br /> PE Sc Received Check#/ Amount ermit/ <br /> Code INFOBV ) Remitted ate Service Request# Invoice# Permit ID# <br /> r rSyrs, <br /> Y,3 ,22 <br /> 42-01-001 <br /> 122 02 ONSITE WASTEWATER PERMIT <br />