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11`x' <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FL-STOCKTON CA 95202.ON)168-3420 <br /> NON-REFUNDABLE PERMIT CAIL 2091953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> CROSS STREET �� APN OEJ !' �Tv - 1 V PARCEL rIZE l� v <br /> J �I e <br /> OWNERNAME �1L PHONE �{ l <br /> OWNERADDRFSS �� 1 v- ������ `' CHV/BTATFIZIP <br /> CONTMCMR U PHONE <br /> CONTMCFO0.ADORRR4 Cr ISrATE/Z1P <br /> LICENSE ❑C<2 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPFH: ft GEOGRAPHICALINFORNIATION: C.Idi-YhF X Y <br /> PERCTEST N I BUILDINGPERMIT# LAND USE APPLICATION III <br /> TYPE OF WORK: ❑ NEW INETALIATION ❑ RCPAIR/ADMION ❑ ENCINLERDESICNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILLRVE: ❑ RESENCE ❑ COMMERCIAL L3 OTHER <br /> NUMB ER OF LIVING UBEID <br /> NITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPFIMFG CAPACTY pt NOFCOMPARTMEWS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY SRI NOFCOMPARTMENTS h <br /> ❑ PKG TX PLANT DIWANCEMNEAREFT; WELL ft FOUNDATKIN ft PROPERTY LME R <br /> ❑ LIFTSTATION HIM TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS #OFLNEs LENGTNOFLmes ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETON"R WELL ft FOUNDATION R PROPERTY LME ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE M NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DIWANCETONEAREST WEI-L R POUNDATION - ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIUTx ft LENGTH R DEPDI ft <br /> DISTANCE M NEAREST WELL R FOUNDATION ft PROPERTY LIKE ft <br /> ❑ SEEPAGE PITS NUMBER Wm. ft DEng ft <br /> DInANCE M NEAREST WELL ft FOUNDATION ft PROPERTY LME 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 JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR AD%ANCE NOTICE REQUIRED FOR INSPECTIONS-PLf:AS;C�ALL(?�09)�95]469] <br /> 814TiEO TITLE li✓�-S.� L+�T DATE y <br /> �C <br /> O IN <br /> H 2E Z yr, <br /> TT <br /> DEPARTMENT _– <br /> ApplbRlbn Atpl <br /> y DRte Arn Employee ID# <br /> DRf,.- i moi' 13SPECIAL PERMIT-Aproved by <br /> h oTl P Plt/Sump Sall Chmcler: <br /> COMMENTS 4' - � '- r' �" - ^ <br /> �Q <br /> PE SC Received bN ARmuDI D.7Permit/ IRvokeAl Permit lDX <br /> Code INFO RemiRed Servitt ueMM <br /> 222 21 3S L'" ai <br />