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10° ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 58 too Z,zi s-; <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3-FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS .z.�("� Fefee LJriyr CITYlZi�P -5� Cf:Akfj2. g5-2QS <br /> CROSSSTRELT W1QL)d WY APIN ' ^fins t PARCELSIZE 1-C17 C&4aa:S {pb� <br /> OWNERNAME Cry-[, -Z(-:+�/L.(�/NC. - PHONE �^ <br /> OWNERADDRESSt'' ,l CITY/STATE/ZIP <br /> kJ <br /> CONTRACTOR ein-{1^r-1 - Mie— i [PHONE 1KJY�^Y'AF6�/ylJ-iS <br /> CONTRACTORADDRi..SS :27S'25- C--:27S'25- C-- Myr}le S-h CIT1'ISTATFIZIP JTa(.{ i C4 <br /> LICENSE ❑C-42 ❑C-36 OIHER -'S NUMBER 146 72,5 L EXPIRATION DATE I t`.J <br /> WATER TABLE DEPTH:_ R GEOGRAPHICAL INFORMATION: Coordimtef X Y_ <br /> PERC TEST(S) NUMBER I LAND USE APPLICATION# _ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEERDFSIGNLU/ALTERNATIYF <br /> ❑ REPLACEMENT ❑ DESTRUCrioN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER Op BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG— CAPACITY gal 4 OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG_ CAPACITY gal B OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCET'O NEARLST: WELL A FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIPt TYPE OF PUMP O SAND OIL SEPARATOR(ENCLOSEDSYSI'EAt) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES fY <br /> DISTAP/CETONEARE.ST WFLL R FOUNDATION ft PROPERTY LINE ti <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft Q <br /> DISTANCE TO NEAREST WELL fl FOIiNOAT10N it PROPERTY LINE it �J <br /> ❑ MOUNDED WIDTH ft LEHCTH _ft DEPTH R o <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY LINE it (- <br /> ❑ SUMPS WIDTH ft LENGTH ft DFPTH H <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ DISPOSAL PONDS Wu ru ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS Wluru ft LENGTH ft DEPTH A <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_fl PROPERTY LINE ft <br /> -� 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQLIN COUNTY ORDINANCES <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 1 21 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> -PLEASE CALL(209)933-7697 <br /> SIGNED TITLE_s„7Tpd-r FJ1 A1�/1hGT DATE D <br /> r,+> <br /> � 7� p,Jp Valc;[n I� of N <br /> S�FSl�Ot 0 <br /> ,b fg <br /> N <br /> � <br /> !32' <br /> a?�if�J <br /> Mcapfiay <br /> •A <br /> A.� to <br /> L <br /> DEPARTMENT�USE�/ONLY ��jj// <br /> Application Accepted By ( <br /> ` Date o//`H fiK Area -2-! Employ«IDn_L7/±(� `� <br /> ��— ( 9q <br /> Fiml Inapec<ion Datc�ji���/--�-� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiUSomp Soil Charaeler: <br /> COMMENTS <br /> PE SC Received Chtc Amount Date Permit/ Invoice# Permit lD7J <br /> ' Code INPO B uh Remitted Service Re uest# <br /> p i <br /> 40 3- <br />