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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868f,f fAZEL70N AVENUE-STOCKTON CA MOS-(209)488,120 <br /> NON-REFUNDABLE PERMIT CALL{209)953-7597 FOR INSPECTIoNS EXPIRES 1 YEAR FROM DATE ISSUED <br /> fJoe ADUR£SS Z .7 ..s ._.__ l �. L'- -- CiTYfLtP -- �C+ c?—) <br /> It- 41, PARCEL SIZE.-L4 a <br /> GROSS STREET _._._._.- �"_:::-?'?'6 v L. .. APIC_,.__ ...( ._.1­4ZL .__..._.�_._._. <br /> l( OWNER NAME_ PHONE <br /> OWNER ADDRESS _- � \�) _._._...__......._...._ ..._..._..... <br /> . <br /> G3N7fAOTOR. _ �aj � PHONE <br /> CONTRACTOR ADDRESS _�s�. ,,._..'.�.!... "� ... CITYI57ATE373P <br /> �f l �- 11 <br /> LICENSE .,i"2 �_,"C-35 OTHER—__.../4._....._.._� NUMBER_y_��-I�.�.._..EXPIRATION DA-E._.....z,1_3`�`_yC } <br /> '� <br /> l WATER TABLE DEPTH:. `,�D n GEOORAPHICAL IN1 ORMATIDN: COOrdinat6S X ._._ � Y_-.-._—.._. l� <br /> PERC TEST I BUILDING LOERMIT#..... _ _.__LAND USE APPLICATION If _ <br /> TYPE OF WORK: NEW INSTALLATION -+ -REPAM/ADnrrWN ENGINEER DESIGNED IALTERNATtVE <br /> REPLACEMENT .......... OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION ._-. <br /> INSTALLATION WILL SERVE: NE`SIDENCE COMMERCIAL OTHER__ <br /> ! NUMBER OF LIVING UNITS:. _. .. y._...__._. NUMBER of BEDROOMS: NUMBER OF EMPLOYEES:��, <br /> 0 SEPTIC TANK TYPE/1,AFG CAPACITY —__ gal is OF ConaPARTMENTS_._- <br /> Z) GREASE TRAP TYPEIMFC, _. CAPACITY --_,,.,-.----.. gat A OF COMPARTMENTS <br /> - i <br /> DISTANCE 70 NEAREST: WELL­--- ft FOUNDATION ft PROPERTY LINE ft <br /> Q LIFT STATION SIZE _._ TYPE OF PUMP_.,,:,,. CI PKG TX PLANT 0 SANDOIL SEPARATOR(ENCLOSED SYSTM <br /> gr LEACH LINES LEACHING CHAMBERS-- - #OF LiNE5— _--LENGTH OF LINES :IT <br /> DISTANCE To NEAREST WELL ft FOUNDATION (� it PROPERTY LINE <br /> CI FILTER BED WIDTH ft LENGTH DEPTH- - _ ft <br /> DISTANCE TO NEAREST WELL_._..._.__..—.__ It FOUNDATION .,,—,_._.ft PROPERTY LINE ft <br /> © MOUNDED WIDTH_ _--­It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WEU----_- It FOUNDATIONft PROPERTY LINE 1t <br /> I0 SUMPS WIDTH.._..___.. �...__-......_.._...ft LENGTH <br /> �...._,y..,...,_.......... _..... _ DEPTH ft i <br /> DISTANCE TO NEAREST WEN-_ 4v6� t_,_- it FOUNDA710N 1 O it PROPERTY LINE ft Ij <br /> ❑ DISPOSAL PONDS WIDTH______.--_R LENGTH__...-_.._�...._-------_ ft DEPTH ft ! <br /> DISTANCETO NEAREST WELL—.—,,,.,,,,_„-- ft FOUNDATION ft PROPERTYLINE N I� <br /> ❑ SEEPAGE PITS Nveaa£RWIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELL-�___.Y..... It FOUNDATION _ft PROPERTY LINE f; <br /> I I IEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 2 QUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEAS CALL 7517 � <br /> SIGNFI7,--- - - TITLE_.> ;.�,., X � DATE ._.. <br /> -77 <br /> FT <br /> -Til <br /> 1 i <br /> I <br /> i <br /> i <br /> I' <br /> i <br /> i i i <br /> 4.4 <br /> DEPARTMENT USE ONLYn <br /> Application Accepted B Date .�. Area :. IL <br /> EmploYee i <br /> Final Inspection By Oate_.�..�.1.!�.__. L SPECIAL PE MIT-.Approved by. <br /> Character of Soli to De th of 3 Ft:-___.,__ PRISUMP Soil Character: <br /> CONfA9 <br /> PE SC Re Checldf Amount Date Permit! ITIVoIts NI Permit IDI <br /> Code INFO B Remitted Service Request k <br /> 32-07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4PS;12 <br />