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i <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOADWrt COUNTY&mRomeNTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(2 9)40.3420 <br /> NON-REFUNDASLE PERMIT CA 209 963-7697 FOR INSPECTIONS / EXPIRES I YEAR FROM D TE ISSUED <br /> JOB ADDRESS ,t �,(�^}"rC GCITY72yP 1✓�' .L..� ��5 �.}1 <br /> CROSS STREET '-�?��"� APN_ -2- a—> U�j PARCEL SIZE _— 1 n <br /> OWNER NAME � *'V� �_--•�_ PRS I <br /> Owt"ADoms CMYlSTATE1ZiP I .. <br /> CONTRACTOR T s^' I1i'�A, "' d,�3 �-,-'s;',''`' PHONE <br /> CONTRACTOR ADDRESS I""7 ' '.✓_i„J.'C."-�^•r•- CiTYISTATE17Jv ✓�"�'"'" ',-r' S `I . <br /> LICENSE ,;C-42 i„C-36 OTHERiMSER�I SL'J�'1' ExPiRAT1av DATE <br /> WATER TABLE DEPTH; ft GEOGRAPWCAL INFORMATIOW CODrdinateS X Y <br /> PERC TEST 0 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: lu NEW INSTALLATION REPAIRIAOMTION1. E1dOWEER DESIGLtlED fAL RNA <br /> REPLACEMENT d.-f"+'�G4ti' 4' DESTRUCTION <br /> iNSTALLATION WILL SERVE: -e RDENCE COMMERCIAL OTHER <br /> ESI <br /> NUMBER OF Lr✓ING UNITS: NUMBER OF BEDROOMS: NUMBER EMPLOYEES: <br /> m SEPTIC TANK TwLI)AF0 .. t �'p 4 C� _ CAPACITY_ r 2 c S x✓ gat of Co Paz:xtNxs <br /> ❑ GREASE TRAP TYPEIMFG _ <br /> CAPACITY #oFCOMPART?£NTS <br /> DISTANCE TO NEAREST: WELL '� ft Fou -n ft PROPERTY L.LNE R <br /> 13LIFT STATION SIZE TYPE OF PUMP C1 PKU TX I ljgi M'G.-.- SAND,,PfL SEPARATOR(ENCLOSI D SYSTEM <br /> { <br /> 0 LEACH LINES e LEACHING CHAMBERS -0-Z #OF L WES 'S- LENGTH OF LINES � R <br /> DISTANCE TO NEAREST WELL SCJ ': fOUtdD?+71pPd...___ R PROPERTY LIAE,— <br /> a FILTERSED WIDTH ft LENGTH DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION.——ft PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION„ ft PROPERTY LINE ft ! <br /> ❑ SUMPS WmTH R LEN:iTH R DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY UNE ._ It 1 <br /> 3 DISPOSAL PONDS WIDTH fi LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST.-�.WELL It FOUNDATION R PROPERTY LINE ft `.. <br /> O SEEPAGE PITS N"SeR WOTH __ ft DEPTH_...__ __ ti <br /> OWARM TO NEAREST WELL It FOUNDATION R PROPERTY UNEft <br /> I HERESY CERTIFY THA T i VE PREPARED THIS APPLICATION AND THE WORK WIL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY S. ! 214 <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> iKIMUN 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20'9)953.7697 <br /> SIGNED Ti�i-ES.��--. ��,�,�„-- DATE '� '� <br /> I <br /> i I I <br /> L <br /> I <br /> i <br /> 1 <br /> •I <br /> DEW, <br /> Ll� <br /> ////// PARTMENTU ONL <br /> Application Accepted to _:IArea Employee IDs' 999 <br /> Final Inspection By oats r, $-£DUAL PERMIT-Apprw»tl Dy <br /> Character of SoU to pth of Ft PI p Sail Character: <br /> COMMENTS OCO. <br /> PE SC Received ac Amount Perritt Invoice 8 Permit 100 <br /> Code INFO Remitted I Service Re t* <br /> 42-01 ONSITE WASTEWATER T T SYSTEM PERMIT <br /> 101AXi7 <br />