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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 2�D <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 309E WP.RERAVE-3YIRL-STOCKTON CA 95202 -0")96B-I4I9 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 151 <br /> 1I�Y {• l CI <br /> yTY <br /> //�ZIP /i GOA M7I�J 1 Cq q <br /> CHOSE$'TKLUT <br /> LTQIT Q AFN_OO-] - 1—lli— IO PARCEL SIZE I� <br /> OWNERNaMEerh �• l� � PHONE <br /> yl <br /> OWNERADDRIM 1 � � ;I rLci�\ IZQ Cnv/SmATL/]AP <br /> CON'rRAcrDR 1�• 1��t �� L`t'� PHONE v) <br /> CONERACTORADDRFSS CITY/STATEJZIP ` <br /> LICENSE O C42 O C-36 OTHER NUMBER. EXMRATIOY DATE L <br /> WATERTABLEDPTPN:_ II GEOCRAPBICALINFORMATION: Coordinating X V <br /> ❑ PERC-TEST(S) NUMBER LAND USE APPLICATION N �.. <br /> d <br /> TYPE OF WORK: O NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER OCSIGNED/ALTP.wNATIVE (O <br /> 0 REPLACEMENT O DFSTRGCOUN <br /> INSTALLATION WILL SERVE: REM.CNCE LJ COMMERCIAL ❑ OTHER <br /> NUMBER OP LIVINGUmES: NUMBEROFBEDROOMS: NUMBEROPEMPLOVELD <br /> SL <br /> ❑ SEPTIC TANK TVPVMPO CADACTTY gal 4 O COMPARTMENTS <br /> ❑ GREASETRAP TVPF(MFG_ CAPACITY gal SOF-COMPARTMENTS <br /> EIEKG TX PLANT DISTANCETONEAREST: WELL 6 FIXMDATION fl PROPERTY LINE H <br /> ❑ LIFTSTATION SIZE TVPP.OPPUMP ❑ SAND OIL SEPARATOR(ENCIA)SEDSY81'[M) <br /> _) 111 LEACH LINES ❑ LEACHING CHAMBERS h- SOF LINES ' LENGTH OFLInES rcrl D <br /> DISEANCETONEAMDr wfu 1-PO B FOUNDATION _R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTX B LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION--ft PROPERTY LINE ft <br /> ❑ MOUNDED WHITS R Lemam ft DEPTH ft <br /> DISTANCEI'ONEAREEr WELL—_ft FOUNDATIN_ ft PROPERTY LINE A <br /> ❑ SUMPS WIDTH A LENGTH _R DEPTI ft <br /> DISTANCETONEAREST WELL _ft FOUNDATION_ R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ R DEPTH ft <br /> DISTANCETONEAREST WELL _ft FOUNDATIN A PROPERTY <br /> LINTE'—--R <br /> SEEPAGE PITS WIDTH I(-ZII ft LENGTH R DEPT. ZJ ft <br /> DISTAN TONGRES'T WELL 1- o R FOUNDATION ft PROPERTY LINEft <br /> I HEREBY CERTIFY THAT E PREPARED T HIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M M HOUR ADVANCE NOTICE REQUIRED FUR INSPECTIONS-PLEASE CALL(209)953-707 <br /> SIGNED TITLE_ DATE <br /> 12 1 <br /> P _! <br /> IVET <br /> 20 <br /> E Yifl NM Ni <br /> 6 <br /> LN <br /> I li� i <br /> Z <br /> DEPA MENT SE ONLY <br /> AppliolkD w«eged8 Dale �'Z7-'O� A. �-I L Employee lDS_ <br /> FIoal tinperti.R B DBk /�n 3 ❑ SPECI PERMIT-Ap,n.ed by <br /> Chaoeteraf5 it to Depth 3 FD _ PIUSump SDil Ch.Y.Mr: <br /> COMMENTS Q� <br /> PE SCReeNVed M1ee A...t P.n <br /> Cede IRPD B eh Remltkil I. Service Re IovoluY P<rMi1DS <br /> 14-1,101 IIS I C A 3 i <br />