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Z'+2 A <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468J420 <br /> NON-REFUNDABLE PERMIT _ C_AIL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ..._Joe ADDRESS L -I+'"\L��Z \1�h), _ CITY/ZIP LC <br /> CROSS STREET <br /> (' APN o r l 1. LD.1 ( PARCEL SIZE 015" <br /> _ - <br /> C�.tc.��nj._ I S <br /> Tv lr> E <br /> OWNERNAME 'v �I` PHONE <br /> OWNERADDRES$ 7�L�\}:_t_.�1�`].n:'Sr CITYISTATE/ZIP <br /> CONTRACTOR _W"`. Q,-'ZAA1. v^IL.F\:L-L IN .� I I PHONE <br /> CONTRACTORADDRESS -_.-.6 ♦VYYvl1` S t CItY/SIATF.(ZIP <br /> Q <br /> LICENSE ,C-42 ,C-36 OTHER !` NUMBER b'�fAS J EXPIRATION DATE <br /> WATER TABLE DEPTH: IT GEOGRAPHICAL INFORMATION: Coordinates X Y ;vim <br /> PERC TEST r _ BUILDING PERMIT# (, LAND USE APPLICATION# <br /> --WINS-_1 �. - _ . _— <br /> TY�E OF WbRK: —N <br /> � EW 1lSTAlIATION /C REPAIR/ADDITION ENGINEER OES!GNEDlALTERNAT <br /> I 3 <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION:j4 <br /> - WWII-WWII-- WWII- --- WWII O <br /> INSTALLATION WILL SERVE: 1>RESIDENCE COMMERCIAL OTHER---_ <br /> NUMBER OF LIVING UMTS: _ — NUMBER OF BEDROOM5012 NUMBER OF EMPLOYEES: A <br /> S: <br /> C& SEPTIC TANK TYPE,MFG --? ,- _ CAPACITY _ZoVJ. _. _ gal #Of COMPARTMENTS <br /> ❑ GREASE TRAP TYPE,MFG CAPA`1TY 9N #OF COMPARTMENTS <br /> 1' <br /> OISTANCETONEARLST: WELL Il F1'.I N4CUq 1Ci1J It PROPERTY UNE It O <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 14 <br /> �_ LL,C' <br /> 13 LEACH LINES ?L-LEACHING CHAMBERS I)`1 T„.(A IJ ps #OF LINE:S ?, LENGTH OF LINES h 1 <br /> DISTANCE TO NEAREST W4il. 1:7J 11 'IAINUARUN_ .�- IT PROPEHTYONE <br /> ❑ FILTER BED WIDTH ft Lf WC TN It DFPT1/ It <br /> DISTANCE TO NEAREST WFLI. __. It F-OUIR)A1:UN _ _. If PROPERT-Y IINI, - h <br /> ❑ MOUNDED WIDTH It LENGTIT h DEPTH It <br /> DISTANCE To NEAREST WELL it FOUNDATION -__— _ It PROPERT'UNEIt <br /> L SUMPS WIDTH (�, It LFN(;TII �Y_ .. It DEPTH_C;) <br /> DISTANCE TO NEAREST WELL It FOUNIDATION -_ ft PROPFFiLy UNE <br /> ❑ DISPOSAL PONOS WIDTH _ i1 LIrN;It _- It DLPTH __ <br /> C h I <br /> DISTAN::E TO NEAREST WELL h IrXJNDATICA4 h PROP/V�� _ __It ` <br /> ❑ SEEPAGE PITS NUMBER— WIDTH _ If DEPTH �"_{L/^�+C`'R{t�. �� h <br /> DISTANCE TO NEAREST WLU- It FVTL01LfAZION If PROPF I`.T`"I.9 I 7015 . _. n <br /> I HEREBY CERTIFY THAT 1 4AVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN (1 w6'(Mj9A FIANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY, HEgL TI IMLN FAL <br /> •r IO <br /> DF 1> <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL f2UN <br /> SIGNED. . c`. - ..-- - TITLE �f tSIOtW�I - WWII- DATE-G i I.IIS <br /> I �T <br /> i <br /> iH tI - <br /> `I yIra --f- - - - - <br /> -�-�- <br /> / , l <br /> 1_.. ' <br /> / CEPARTMENTU E <br /> Application Accepted By -; .�( Date �� Area . l �S r " <br /> ` - � J 'T Q'`l .ZI_.1 Empbyee IU#- -�`f- <br /> Final Inspection By _ Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiUSump Soil Character: <br /> _ <br /> COMMENTS <br /> Gl�-�i_�� I�r'.��.U,c .I'?'rr'�/.�_v- ( ,- -. -,-,i A.�wL <br /> L�'�,-k.L!-tl� I ✓CN � E.LL.� .�� _'S�t' y _f...4+(u"�. �,%4-i3��� <br /> ---- <br /> _ -- -- ---- <br /> PE SC Received Check Amount Permit/ J l <br /> 1—--- Dale Invoke t Permtt IDs <br /> Code INFO B ash Remitted _Service Request# _l <br /> {z� - - _ J <br /> ''1 GNSITE WASTEWATER THTMNT SYSTEM PERM1i <br /> 4,24.'17 <br />