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vl wl I #eno I QvII 1 CR 1 ICCH 1 IVItIV I ATJ I tM I- LKMI I H' ✓ <br /> SAN JDApDIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS &100 S• .9—jANLE1/ {2D. Cn TRIP S7VUcTnN qv-,243- <br /> -4 -0190 <br /> v Z(r� ,I- <br /> CROSS STREET 6140 13 Lt RD. APN 10 -4 -0190 Y ��o PARCEL SIZE •O-7 Rte• <br /> OWNERNAME �TOIr1'S r�--SLt•Y a$. 1•J, 1(^��y)�(„ t C rs')PHO�NEL 4'F3- <br /> .�A�ZO.) r- �+ <br /> • OWNERADDRESS _&f n S• S I An)LEW I'-'� CITY/STATEZP Sr0C�TDr J• CA 9S2•I J <br /> CONTRACTOR LIVC��JO/hK G�PF%Mr40PJM6:,V `pt L- PHONE 341CI-03�7T- <br /> CONTIACTORADDRE14SS 03 Pu- cAir- s • CT-/STATE/LP LOV I F LEFT 9T7-,A0 <br /> LICENSE ❑,C-42 OC36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTI: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> DQ PERCTEST # I BUILDING PERMIT# LAND USE APPLICATION# PA-1(aOOJ•ZS <br /> TYPEOFWORK: ❑ NEW INSTALLATION ❑ REPAWADDITON ❑ ENGINEER DESIGNED/ALTERNATNE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OFLMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> (3 SEPTIC TANK TYPE/MFG CAPACITYgal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE To NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ UFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS III OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH R <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE To NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ sumps WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSALPONDS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGEPITS NUMBER WIDTH R DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> • I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONEIN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> I MUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-7697 <br /> SIGNED TITLE G0r VAULT&t T- DATE <br /> 'I� IPa stl <br /> .:-I lddl~ <br /> E <br /> F <br /> CD0I-� <br /> �LU=c <br /> 3 �'d za <br /> S <br /> F. 5zLU <br /> opo <br /> x <br /> pp �z <br /> 3i DW <br /> O = <br /> i° <br /> DEPARTMENT U E O Y q <br /> Application Accepted By - DateArrea C� Employee lD# ! C OL�LCS <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiVSUMP Soil Chaaeter. <br /> COMMENTS <br /> • PE I SC Received Check#! Amount Permitl <br /> Code INFO B Cash .Remitted Date Service Re nest# Invoice Permit ID# <br /> vZ S�> 1 C7 r39• 3 � sRIXi <br /> 42-01- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />