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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL htA%III DtPAA TMEN1 1868 E.HAZELTON A:ENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOP.INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESSY �/ ` f.,, ��>�j_✓'✓�Lam_. - r� _CITY/ZIP/ls �, qI '7)T_/ <br /> CROSS STREET �r^f /Ti�7/d'i�(. 6t,/ APN�i�]' _-J- r�I��-^_ PARCEL SIZE <br /> OWNER NAME�/�/SIO U C�(/��U/(y�_�F e -_�y1 __-_ PHONE __ T <br /> OWNER ADDRESS f�CITY/STATE/ZIP ` <br /> CONTRACTOR_ GLi/i,'( .,�.�( l >TCJ�,�F_(� =L( EG�y�rc PHONE <br /> 2 <br /> _ I�-y,�/ �c•�//,f7U 7�- §ft <br /> CONTRACTOR ADDRESS �,L "_, /_(�,�>,f(/,_-_✓,b- _ CITY/STATE/ZIP "1-/'s <br /> j�/= '-'�4 L-/'S <br /> LICENSE ,�,C-42 ,C-36 OTHER - NUMBER S074?0 1 EXPIRATION DATE <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #__ LBUILDING PERMIT# -.._ LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT -—_ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION_ <br /> INSTALLATION WILL SERVE: �'. RESIDENCE ,COMMERCIAL OTHER - <br /> NUMBER OF LIVING UNITS: _.__....._._._.___ NUMBER OF BEDROOMS:-- _.-.-, NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG �t L' CAPACITY ?-Dn!J _ gal #OF COMPARTMENTS L _- <br /> GREASETRAP TYPEIMFG i�.r CAPACITY .1:r_0 iJ gal #OFCOMPARTMENTS Z-- <br /> I <br /> DISTANCE TO NEAREST: WELL II FOUNDATION S_ _ It PROPERTY LINE -/O 11 <br /> ❑ LIFT STATION SIZE _.TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> A —--- > <br /> LEACH LINES LEACHINGCHAMBERS #Of LINES LENGTH OF LINES 5/D N <br /> DISTANCE TD NEAREST WELL _ It FOUND ATI Il l 11 P R Y NE R <br /> ❑ FILTER BED WIDTH it LENGTH O PTH _b <br /> DISTANCE TO NEAREST WELL It FOUNDATION - �6�PIR T LININ___R <br /> ❑ MOUNDED WIDTH—___ -_-__it LENGTH---__---- may b&9 V �l�}�TT7 _It <br /> DISTANCE TO NEAREST WELL h FOUNDATION, C �+ rY�R �•T.L4^1 f R <br /> ❑ SUMPS WroTN __it LENGTH_---- y DIEIVT� ur)ns R <br /> —��-= ^, <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONt •�Ij� R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH__— R DEPTH <br /> — -ft <br /> DISTANCE TO NEAR ST WELL ___It FOUNOATION _ it PROPERTYLIIIE—_ it <br /> SEEPAGE PITS NUMBER____- WIDTH__ _ y/ II DEPTH Z15- R <br /> DISTANCE TO NEAREST WELL _]�rN it FOUNDATION �•7 ft PROPERTY LINE_ -� it <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 /> MINU.1 M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 l <br /> SIGNED ��- TITLE- �:.'-� /J_ DATE �- L y <br /> - __------ - <br /> UA UI <br /> N <br /> 2/ <br /> Application Accepted By—A^ nhpEPARDTaMte=4149 O8NLY Area CCY'a/ <br /> eL_. Employee ION <br /> Final Inspection By-__ _— Date_ ._ - 1! SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth Koff 3,6Ft:__—__ _ Pit/Sump Soil Character:_ <br /> COMMENTS lli4c "d- i- '° >'7_2/c-, Lx" SteT"l <br /> (42 1/r <br /> -- -- - ----- ------------ <br /> PE SC Received heek#/ Amount Date Penn t' Invoice# permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01 014SIIE WAS TEWATEH TRTMNT SYSTEM PERMIT <br /> 4/2412 <br />