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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> i SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"0 FL-STOCKTON CA 95202 -(209)46ii-3420 <br /> NON-REFUNDABLE PERM46 <br /> " CA L 209 953-7697 FOR INSPECTIONS ~EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �(!!/ CITY/ZIP )f�' y <br /> CROSS STREET APN a55 46 OPV PARCELSIZE53 a <br /> n� ) ��w,1 <br /> 1 OWNERNAME / A D F� S�i�itQ lf'•/�I./ '� PHONE,A(DY�dJ� 7f E <br /> OWNER ADDRESS �Q " Iti(1 Q ' " CrrY/STATE/ZIP'-77,7_r_V, g!!zj0V�, m <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CrrY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#t) -70Z q 7 LAND USE APPLICATION# ' <br /> TYPE OF WORK: NEW INSTALLATION LlREPAIR/ADDITION. ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ 'REPLACEMENT I r ❑ DESTRUCTION ' <br /> INSTALLATION WILL SERVE: eRESIDENCE. O COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNIT'S:' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE IMFG 7"r - CAPACITY / DO gal #OFCOMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPF./MFG CAPAC gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE To NEARLW: WELL ft FOUNDATION ft 'PROPERTY LME R <br /> { ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENC-Lonvftsw ) <br /> LEACH LINES ❑ LEACHING CHAMBERS #of ES �' LENGTH OF LINES dam' ft S <br /> DISTANCE TO NEAREST WELL ft FOUNDATI N- R PROPERTY LI E R e <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH R ❑ <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST' WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH - - - ft LENGTH - ft DEPTH - it (n <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH- ft DEPTH ft <br /> DISTANCE TO NEAREST WELL • ..R FOUNDATION fl_ PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH, ft <br /> �. DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �R <br /> I HEREBY CERTIFY THAT I 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 ADV NCE NOTI REQ UUI^2ED FOR INSPECTIONS=PLEASE CALL(709)953-7697 <br /> SIGNED Q.yYIA�1` /PC O'�+-� TITLE O wAJE-2- DATE <br /> I I NEW SEPTIC <br /> SYSTEM <br /> 1 . <br /> i�it 1• Vk - <br /> 139, <br /> RES DE <br /> �UP1 1 9 2n01 o NEW WELL, <br /> pulry <br /> COLOV <br /> SfSI��pNMEtSIa�� , <br /> I H�jTt1 pEPAFCSM I.I (o <br /> 1 mo A 156' +/- ' <br /> ,­DEP"TME - <br /> Application Accepted By <br /> to 0 - Area Employee ID# ��s <br /> Find Inspection By (e "ILDIJ'. Q SPECIAL PERMIT;Approved by <br /> Character of Soil to Dep of 3 FL Pit/ ..p Soil Character: <br /> COM NT �. <br /> PE SC Received Cbee Amount Permit/ <br /> Code INFO - By- ash- — Remitted Qn1e .Service nest# Invoice# Permit ID# <br /> 4241 11-7 00 0 'cnJ 15 <br /> 42.02-001 -- - +- - - ONSITE WASTEWATER PERMIT <br /> 12/222003 <br />