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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 660 E MAIN STREET-STOCKTON CA 95202-(209)468-3620 <br /> NON-REVUNDABLEPERMIT o CALL 209 953-7697 FOR INSPECTIONS EXPIRES YEAR FROM DATE ISSUED <br /> JGB ADDRESS #.;IJ�99'T '7�/'n-{o n cITY/Lle 7/u rn-Jnw <br /> CRGNSSTREET S'A14c4A AIN 00/_ /1n0'- 07 PARCEL SIZE G.2-16 s <br /> e <br /> OWNER NAME 7% r✓2[04 PRONE <br /> OWNER ADDRESS / [` CITYISTATEJZU <br /> CONTRACTOR C� � (IQ� .,W, l e PHONE zoo- S&:q7 <br /> CONTRACTORADDRBSS 17000 CITVISTATE/ZIP <br /> LICENSE }3 C42 O C-36 OTHER NLMBE0.�Q•,/cJ[PxUT10N DATE <br /> WATERTABLE DEPT11: B GEOGRAPHICAL INFORMATION: CPordimom X V <br /> 13 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORN: U NEWINSTALLSTION Ak REPAIR/ADDITTrON(_ ENGINBPRDESIGNED/ALTERNATIVE <br /> O REPLACEMENT iR--DPBFRII[TION G G'.� T�"'i •'L� <br /> INSTALLATION WILL SERVE: RFSIDEN" V COMMERCNL 13OTHER <br /> �C NIIMBEROFLIVDSGUMTs. /� NUMOER OF BEDROOMS: NUMBER OF EMPLOY - <br /> p SEPTICTANK TYPPI 41, G,.T. I CAPACfPY �lc'OO mi MOF COMPARTMENTS <br /> O GREASETRAP TYPFJMEG_ CAPACITY gal #OFCOMPARTMFNTS <br /> DISTANEETONEARASI': WELL •-L15"1L ft FoIINDATION /QI ' _ ft PROPERTY LENS 30/ R <br /> O LIP'STATION SIZE TYPE OF PUMP O PKGTXPLANT O SANDOMSEPARATOR(ENCLO&RDSVSTEAIJ <br /> O LEACH LINES Id LEACHING CHAMBERS #OP LIVES � LENGTH OF LINES �D� R •`1 <br /> DISTANCETONEAREST V/ELL .L EiLCL- ft FOUNDATION %!J I ft PROPERTY LINE 30 ft <br /> O FH.TERHED WmTx ft LENGTH ft DMH R <br /> DmANCETONEAREST WELL ft POLT•DATION_ ft PRN'ERTYLTNE It <br /> Q MOUNDED WDxx ft LENGTH D DEPTH R <br /> DISTANCETONEARPST W ft FOUNDATION. ft PROPERTYLINE ft <br /> O SUMPS WmTx ft LENGTH_ R DIPTIi It 6 <br /> DISTANCE TO NEAREST WELL _R FOUNDATION ft PROPERTY LINE R >� <br /> O DISPOSAL PONDS WmTB ft LENGTH ft DEPIN ft <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LDIE ft c^il <br /> 0 SEEPAGEPITS NuMeap WIDTH ft DEPTH It L, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WELL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGUI.STIONS OF SAN JOAQU IN COUNTY. <br /> MINIMUM 2I HOUR ADVANC DUCK REQUIRED FOR INSPECTIONS-PLEASE CALL 0209)953-7697 �I <br /> SIGNED TITLE_ DATE <br /> J <br /> 4 <br /> I <br /> Ab <br /> 0 L <br /> i <br /> mlodub IY <br /> V O M N Q /�Y• <br /> �, DEPARTMENT 'S <br /> Appliation A«epW Hy Date 9 / Ara it J <br /> Final lmpacRon By ''�� Do, / J/y &K ❑ SPECIAL PERMIT-Approved by <br /> CharatteT of Soli tR Depon or3 FL PIUSpmp Sail Chene4e: <br /> COMMENTS U A ttlT of <br /> PE SC Reeeived I Cb A.= Date PermhJ IRVOIaM erMtIDM <br /> Code INro CUR RaBdHW SerYta eat# <br /> 1I G I�So•!ti 11141toK I )O <br />