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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888E.HAZELTON AVENUE-STOCKTON CA 95205-(209)46&3420 <br /> r�NON-REFUND P MIT L 209 953-76 FOR INSPECT7ON E% RES 1 YEA FROM DATE ISSUED <br /> JOB AppRE59 _ <br /> CROSS STREET V—�_ H`� APNS,jA,1._ 2M:0'j l:0' _PARCELSIZE �0 _ o <br /> OWNER NAM --DD PNOHE <br /> OWNER ADDRESS L /y{� I <br /> _CmISTATEA21P�.,LIJ({']j_I_/I�) <br /> DOfRAArTOR�. p..A-r-yQLys�j fi��l�J�/y� <br /> CONTRACTDRADDRESS '�LL.�](�����//��yA,Y.���A�aL'/�i'y_Cm/BTATE21PU1TA�_V� ��,7(,j,J� <br /> LICENSE '#IC-62 INC-0e OTHEq _ NtmsGRW/S 6t EXPIRATIONDATE N �� <br /> WATER TABLE DEPTH: _ft GEOONAPHICAL INFORMATION: Coordinates % _ _ Y <br /> PERC TEST If BUILDING PERMIT#_1 1 D_ LAND UBE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATKHt x REPAIRIADOITION ENDMEER DESIDNEOIALTERNATIVE <br /> REPLACEMENT OUT-0FSERV ESEPTICSYSTEM DESTRUCTON <br /> INSTALLATION WILLSERVE: RESIDENCE a COMMERCIAL. 'IOTHER <br /> NUMBER OF LMNO UNITS: NUMSEROFBEDROOMB: NUYSER OF EMPLOYEES' <br /> )R SEPTIC TANK TYPE/MFG CAPACITY-A"7-00 gal #OFCOMPARTMENTR <br /> ❑ GREASETRAP TYPE/MFO CAPACITY� gal #OFCOMPARTMENTS <br /> DISTANCETONEAREST: WELL 100-'r X UN <br /> FODATION__ X PROPERTYLINE too ft <br /> ❑ LIFT STATION SIZE -_____ TYPEOFPUMP_____,O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL____ X FOUNDATION X PROPERTYUNE X <br /> ❑ FILTER BED WIDTH. X LENGTH_ X DEPTH _X <br /> DISTANCE TO NEAREST WELL X FWNOATION X PROPERTY UNE R <br /> ❑ MOUNDED WIDTH X LENGTH X DEPTH X <br /> DNTANCETONEAREBT WELL_ X FOUNDATION ft PROPERTYLANE X <br /> ❑ SUMPS WIDTH X LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL IT FOUNDATION X PROPERTY LINE X <br /> ❑ DISPOSAL PONDS WIDTH______ft LENGTH _X DEPTH It <br /> DISTANCE TO NEAREST WELL___ It FOUNDATION X PROPER"LLNE X <br /> ❑ SEEPAGE PITS NUMBERWIDTH_-___.._.._._— ft DEPTH _X <br /> DISTANCETONEAREST WELL________ It FWNDATION___ X PFOPERTYLINE X <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ! D R C EOUIRED FOR IN ONS PLEASE CALL(209)953-7697 <br /> _ AKA _ — <br /> SKiNED_ _______ TITLE _ -- DATE-11 <br /> .. <br /> Lam.- ..+ 1 • • • <br /> L T <br /> EL <br /> vt U <br /> I' A <br /> r{LT ( r <br /> Application Acce*t. . <br /> _ T.Z� ri Emproyea by _SLoS - Dale_l. ❑ SPECIAL PERMR-Apprmed by Ft:_.._ P ump Boll Character: <br /> COMMENTS t iLw ! 'aS4"446 _ <br /> PS4 Gtl O 1 H:! YrDT el Do2R l <br /> PE BC Received Choc Amount PermN! Imoka a PermX ID# <br /> % <br /> Code INPp ItMd Vele $erviCe R ueat# <br /> 1 2.st 7 3 6 960 <br /> p gITP WARTFWATFR TRTMNT RYRTFM PFRMrt <br />