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to N <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT � �� <br /> SAN JOAOU:ICOUNTY ENVIRONMENTAL HEALTH DEPARTMENT I US E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1QYEAR FROM DATE ISSUED <br /> JOB ADDRESS In 7,6 Y�' /� <br /> CROSS STREET //�R C Y XL.✓� ....._...._APN z- 0 �/ � PARCEL SIZE <br /> ?S� <br /> OWNER NAME„__DL�Ir! Sl "PHONE� /[ J��/y <br /> OWNER ADDRESS / , _CITY/STATE121P 7..._..�, ../'A 4. �/1 �?� •• <br /> CONTRACTOR_ _PHONE_.._... ZC <br /> CONTRACTOR ADDRESSro /19 Deno;,” K Q? /CITY/STATE/ZIP <br /> LICENSE j/C 42 ❑CCC 36 OTHER NUMBER_�Z 346 EXPIRATION DATE <br /> p t <br /> WATER TABLE DEPTH: L� It GEOGRAPHICAL INFORMATION: Coordinates X_ Y <br /> (.a PERC TEST # BUILDING PERMIT# �. _._.._. LAND USE APPLICATION*________._ + <br /> TYPE OF WORK: NEW INSTALLATION _ �/ REPAIRIADOITtON ENGINEER DESKiNEWALTERNA�VE <br /> REPLACEMENT I A-k OUT-OF-SERVICE SEPTIC SYSTEM A DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ! COMMERCIAL -Z-t---f 0 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:, - <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gat gal #OF COMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY + _ gal #OF COMPARTMENTS_ <br /> DISTANCE TO NEAREST: WELL I`L7� It FOUNDATION�00_ If PROPERTY LINE Zi it <br /> O LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT O $MND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS NOF LINES _ LENGTH OF LINES ft <br /> DISTANCE to NEAREST WELL_ 1. it FOUNOATION�,�;! R PROPERTY UNE <br /> CI FILTER BED WIDTH_...._ _._.._.It LENGTH _....�. it DEPTH _ _ it <br /> DISTANCE TO NEAREST WELL,_,_.__,._ it FOUNDATION_. _,,,_(t PROPERTY LINE_ _ it <br /> ❑ MOUNDED WIDTH._,Y_._, it LENGTH —it DEPTH It <br /> DISTANCE TO NEAREST WELL _it FOUNDATION it PROPERTY UNE -ft <br /> J SUMPS WIDTH It LENGTH M DEPTH it <br /> OtSTANCE TO NEAREST WELL,_„_ it FOUNDATION it PROPERTY LINE It <br /> DISPOSAL PONOS Wtm_....______it LENGTH <br /> __..—_�.. ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION —._it PROPERTY LINE It <br /> ZI SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> ,DISTANCE TO NEAREST WELL.__.__............................ It FOUNDATION _It PROPERTY LINE ft <br /> I HEREBY CERTIFY ATI 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 /> M/ MU 2�t hl0 ADVANCE NOTICE REQUIRED FOR IN CTIONS-PLEASE CALL 20 953-769/7 <br /> SIGNED DATE <br /> t r' <br /> r + <br /> i <br /> t � <br /> 1 <br /> �✓t U/c <br /> Application Accepted dye°_ bateAra. Empiuy..1D8 ✓ =� <br /> Final Inspection By + r' _ Date _— 0 SPECIAL P RMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pioiumip Soil Character: <br /> COMMENTS , vcrASl "Sr-o€) 'j a..3 <br /> I 40;Da l 1-d + = A .v-,yid'+ <br /> PE SC Received Check#/ Amount Date Perm42 <br /> iU Invoice& Permit IDN <br /> Code INFO B Cash Remitted_ Service Re Ueat# <br /> +f� �5- 1 t�Z S-ot 2to _S100-7500 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 412412 <br />