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'^�ze�6 IDS Iy <br /> ,zlz <br /> r 014SITE WASTEWATER TREATMENT SYSTEM PERMIT �i��c ►)y <br /> SAN JOAQUIN COUNTY ENVIRONNIE N I AL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT I-� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS_ <br /> ' \� _ [�3�_ CIrY/ZIP S <br /> CROSS STREET J^ � - __ APN l�� 3� _:1� _ PARCEL SIZE o <br /> OWNER NAME 1 - _ _ __ PHONE �C� <br /> OWNER ADDRESS _ RLQ' CITY/STATE/ZIP CAgAftwo <br /> T <br /> � <br /> CONTRACTOR l�C_//J�U—J'r'l! _ _ _._ PHONE ��---� <br /> CONTRACTOR ADDRESS s ___],_�J___CITY/STATE21P <br /> LICENSE C-42 I j C-36 OTHER ._ NUMBE4 % 1 1_EXPIRATION DAIS Go / ___-_____ <br /> ,A �O$S <br /> WATER TABLE DEPTH:-__ It GEOGRAPHICAL INFORMATION: Coordinates X __ Y <br /> f. PERC TEST N 1 r BUILDING PERMIT# - LAND USE APPLICATION$_ <br /> TYPE OF WORK: NEW INSTALLATION REPMR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I I RESIDENCE I COMMERCIAL I 1 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:,_ NUMBER OF EMPLOYEES: <br /> SEPTICTANKR)TYPOMFG __ ___ CAPACITY IWVT'^'-'* _ gal NOFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY _ _--_ gal N OF COMPARTMENTS _ <br /> To NEAR <br /> LIFT STATION(3)SIZE Q��TY EIOF PUMPU LT PKO <br /> GTX PLANT L1 SAND OILS SEPARATOR(ATION ft PROPERTY INE Il <br /> ENCLOSED SYSTEM) <br /> "P<6 1100 s�5 - <br /> LEACH LINES LEACHING CHAMBERS N OF LINES 170 LENGTH OF LINES q6.._ _it <br /> DISTANCE TO NEAREST WELLS O h FOUNDATION __ It PROPERTY LINE _ __ __ it <br /> ❑ FILTER BED WIDTH —_it LENGTH_ _ _h DEPTH It <br /> DISTANCE TO NEAREST WELL---- h FOUNDATION h PROPERTY LINE ___ fl <br /> ❑ MOUNDED WIDTH it LENGTH_.__ fl DEPTH_ It <br /> DISTANCE TO NEAREST WELLit FOUNDATION -____(1 PROPERTY LINE _ --It <br /> ❑ SUMPS WIDTH it LENGTH-___ __- _ it DEPTH h <br /> DISTANCE TO NEAREST WELL __ FOUNDATION q PROPERTYLINE __h <br /> ❑ DISPOSAL PONDS WIDTH — R LENGTH) _- _ h DEPTH_ ft <br /> DISTANCE TO NEAREST WELL _ fl FOUNDATION - it PROPERTY LINE h <br /> ❑ SEEPAGE TS NUMBER <br /> WIDTH_ _- _(t DEPTH_ It <br /> DIST NEAFIEST WELL _. It FOUNDATION h PROPERTY LINE K <br /> 1 HERE CERTIFY 11 AT AVE PREP RED THIS PPLICATION A THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE L WS AND RU S AND GULATIONS OF OAOUIN COUNTY. <br /> INIMUM HOUR A VANCE 0T1,CtREQ01 DF SP TIO -PL E CALL ? 9W-76.9 <br /> SIGNED\� / TITLE _ DATE <br /> tv <br /> rl <br /> 'i <br /> ` OEPAfLTh1ENT ._S O N L Y /? <br /> Application Accepted _ Pate - Area _tl ����� , <br /> Emplcyee ID S <br /> Final Inspection By L Date.- _ I SPECIAL PERMIT-Approved by <br /> Character of Soll to pth of 3 Ft: _. I ump Soil Character. _ <br /> COMMENTS Ea1J _ - $ � <br /> 47 <br /> f,Y <br /> PE SC Rccely,l CheckN/ Amount r Permib' <br /> Code INFO B I Cash Remitted Rate 1 Service Requesty Invoice N Permit IDN <br /> Z I* <br /> 1.^. <br /> �� f7s/e.• VGIyr' J�LdAl�d t�a.r`.ws�riwr! q/ ^kS /�li. A.��s1..-! <br /> 42-01 ) NSITETE W'ASTEWA'cH TRYMN SYSTEM PERMIT <br /> 4124112 <br />