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r <br /> ONSITEASTEWA ITER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CA,C.i_(2 953-7697 FOR INSPECTIONS <br /> JOB ADDRESS � EXPIRES YEAR FROM DATE ISSUED <br /> Lt ii 6 op Rec'¢ {�� ��,--Y'C POLE CITYIZIP S+cc <br /> CROSS STREET U P jX�;J/� ��LO � APf\! U�O �� •/ PARCEL SIZE_ o <br /> OWNER NAME PHONE f <br /> OWNER ADDRESSCITY/STATE/ZIP <br /> CONTRACTOR 7,Y)j 6 ee-e PHONE ` S_- - G <br /> ' <br /> CONTRACTOR ADDRESS &)c &, CITY/STATEIZIP Moo i-ce-4p/+� <br /> �G✓I' !S �3` <br /> LICENSE L)LIC-42 DFIC-36 OTHER NUMBER& �"� EXPIRATION DATE �d0 <br /> WATER TABLE DEPTI'1: O ft GEOGRAPHICAL INFORMATION: Coordinates i Y <br /> CI PERC TEST #_ BUILDING PERMIT# LAND USE APPLICATION 41 <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I_I ENGINEE=R DESIGNED/ALTERNATIVE <br /> REPLACEMENT O OUT-OF-SERVICE SEPTIC SYSTEM CI DESTRUCTION <br /> INSTALLATION WILL SERVE: �r SIDENCE I COMMERCIA t4ERNUMBER OF LIVING UNITS: l NUMBER OF BEDROOMS: / / J <br /> U SEPTICTANK TYPE_/MFG; CAPACITI gal # FCOMPARTMENTS <br /> r^ GREASE_TRAP- TYPE/MFG __. CAPACII _ _ (jal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> f LIFT STATION SIZE TYPE OF PUMP D PKG Ty'PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IW----LEACH LINES 7 LEACHING CHAMBERS OF LINES LENGTH OF LINES 4Aj It <br /> DISTANCE ToNEAREST WELL _ Imo_ it FOUNDATIONIt PROPERTYLINE it <br /> C? FILTER BED WIDTH It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> f-s SUMPS WIDTH It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL_ it FOUNDATION It PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH !3�f it DEPTH rz,5� It <br /> DISTANCE TO NEAREST WELL It FOUNDATION �JJ� _ft PROPERTY LINE�� ft <br /> I HEREBY CERTIFY THAT I 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 /> NIINIMUM 48 117) /AJVCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209)953--7697 <br /> SIGNED TITLE DATE <br /> — -I <br /> jj <br /> -- --— — -- <br /> H t <br /> #, RTMEArr JfSr_ t)'LY <br /> Application Accepted By_ Date l Area ?Z7 Employee ID# <br /> Final Inspection By_ _ _ Data `"l 0 SPECIAL ERil,dT-Approved by _ <br /> Character of Soil to Depth of 3 Fi: Pit/Sump Soil Character: <br /> C011II1/IENTS rlgj5��VJ (9.A2E W6VW <br /> PE SC Received heck# Amount Permit/ <br /> Code INBy 1 emitted Date _ Service Request f! Invoice# Permit IDI# <br /> oAMI1.2 •1�1 S_ �- <br /> 42-01 ONSITE WASTEVWIATER TRTMNT SYSTEM PERMIT <br />