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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SIAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL. 2119 953-7697 FOR 1SSPECTI %S EXPIRES 1 YEA FROM DATE ISSUED <br /> n� w <br /> JOB ADDRESS CI Y ZIP <br /> .:y Y R <br /> CROSSSTREET Lit C���� 5 � APN PARCEL SIZ �� y <br /> 0 <br /> c rnt. <br /> n� .h�ld _ <br /> F OWNER NAME �IZ i eoI-JDrJ J-At L D / 3 4 / HONE /TV <br /> OWNER ADDRESS —� � oG� /� '�+ CITY/STATE/ZIP LI ��-7 ' / w <br /> CONTRACTOR / S. c3^ A -/�+/� PHONE &S- <br /> 41 <br /> CONTRACTOR ADDRESS CITY'/STATFJZIP IY/ ✓ <br /> LICENSE A2 ❑C-36 0114LR NUMBER EXPIRATION DATE tuW <br /> WATER TABLE DEPTH: ti GEOGRAPHICAL Ih' .IATION: Coordinates X <br /> ❑ <br /> PE RC TEST # BUILDING PERMIT# LAND USE APPLICATION# \7 <br /> TYPE OF WORK: New INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION (� <br /> INSTALLATION WILL SERVE: Deno: !Nv ❑ COMMERCIAL <br /> NUMBER OF LIVING UNITS: UMBER OF BEDROOMS: 3 NUMBER OF 1PLOVEFS: <br /> SEPTIC TAN *QVTEJMFG &*NC401�'' ����� CAPACITY W V� gat #OF COMPARTMEN"IS_;_ <br /> ❑ GREASE TRAP TYPE/MFGCAPACITY s� gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL rs+✓ fl FOUNDATION J 11 PROPERTY LME ;7J ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) Imo` <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES —2--_ LENGTH OF LIN'F.S 121110 ft 1� <br /> DISTANCE To NEAREST WELL 2UV It FOUNDATION_ /AQ fl PROPERTY LINE tt <br /> ❑ FILTER RED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDA'l1ON ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH (I LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft V <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCF.TO NF.A EST WELL R FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTx � Il DEPTH = R <br /> DISTANCE.TO NEAREST WELL---:f10!6L R FOUNDATION ft PROPER'T'Y LINE �� ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL.BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQU In COUNTY. <br /> IN'IMUM 24 HO .ADVAWCF.NOTICE RF.QI RED FOR INSPECT'1)_A—PLEASSE.CA_LIA209)953-7697 <br /> SIGNED TITLE 1"IJ�"�'—. DATE <br /> d <br /> 00 <br /> 00 <br /> fire <br /> �5 <br /> 200 <br /> ,O IC COUNTY <br /> AN NV NTAI <br /> ATkiENT <br /> I <br /> — ' EPARTMENT <br /> Application Accepte Date Area Employee ID# 3 <br /> Final Inspection By _ _ _ Date / RM - <br /> / G�❑ SPECIAL Aped byy / <br /> Character of Soil to Depth of 3 F Pit/Sump Soil Character: cGGo <br /> � � r <br /> COM ENTS s'UMQ�t_..�_ 4' ODA04r . <br /> (je t P" solz <br /> PE SC Received Check#/ Amount Date Permit' # # <br /> Code INFO By ash Remitted Service Re uesl# �i <br />