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sAN,oAo�)NcaLTIYQa IDAWALTH STE PERMIT <br /> RVICES ENVIRONMENTAL HFALTHDIVISIO� <br /> 307 E.WEBER AVE 3'FLOOR,STOCKTON,CA 9SW2(209)668-3420 <br /> I NON-REFUNDABt..PERMITEXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS �a�(l+/f � MA AVE APN �O/jr Q-' -I- /�'l'Jy'� PARCEL SI7E:��"-•'�V <br /> CITYZP-- C ' 07/7>�� BUILDING PERMIT <br /> OWNER NAME N yf ` <br /> ADDRESS 1 �' <br /> CITYfIdP� PHONE NUMBER <br /> CONTRACTOR ADDRESS /�Q J / �f <br /> CITY/ZIP 4���!^ ��.j�(p PHONE NUM !l/ / (O -7 � z <br /> ~ r � <br /> GEOGRAPHICAL INFORMATION:COORDINATES X y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> A <br /> IP •_ <br /> 'NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: — <br /> ❑ REPAIRIADDITION 13COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF gMPLOYEES: <br /> ❑ ENGMEERED/ALTERNATTVE <br /> CHARACTER OF SOIL TO DEPTH OF 3`: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> SEPTICTANK TYPErMFG_ VL_ CAPAC]TY /60a #OFCOMPA�tTMENTS ` <br /> L3 GREASE TRAP TYPE/MFG CAPACITY #OFCOMP:ZENTS <br /> Q PKGTIL PLANT DISTANCE TO NEAREST; WELL <br /> FOUNDATION ?ROPERTY UNE__ <br /> ❑ LIFrbrATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLASED SN STEM) <br /> LEACH LINE #OF LINES: 7 LENGTH OF LINES: p� y�C¢.I,ON�, WELL-FOUNDATION J� PROPERTY uNE��i <br /> INFLITRATOR CHAMBERS: <br /> Q FiLTERBID WIDTH LENGTH DEPTH OWAKCCTONE REFr, WELL FOUNDATION PROPERTY LINE <br /> Q MOUNDED WIDTH LENGTH DEPTH DWTANCe TO NEMI6f: WELL POUNDA'ON PROPERTY Gh'E <br /> ❑ SUMPS WIDTH LENGTH DEPTH DUTANC1 TO NiiARetT: WELL FOUNDA ON PROPERTY UNE <br /> D DISPOSAL PONDS WIDTH LENGTH DEPTH BRTWCE 1b xEAnEPT: WEU. FOUNDA ION PROPERTY UNE <br /> /�P•- ' <br /> SEEPAGE PITS # �' DIAMETPP` DEPTH 57 aI%T�TomzAm 7: WELT/✓ Z FOUNDA ON PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN OOUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND RECUGITIONS OF SAN JOAQUIN COUNTY. <br /> IYI MUM 2U V .E NOTICE REQUIRED FOR INSPECTION'S-PLEASE CALL(309)468-3423 <br /> SIGNEDATE4D: J <br /> I I I <br /> •_.{__I•--•�-..J__E_j....r <br /> h <br /> ISE 1 <br /> T I <br /> 11 An <br /> 1 i + — <br /> i I I <br /> p <br /> _h -I C71EA1 F, <br /> an <br /> ' <br /> I � <br /> _ I <br /> --�----r--I TT—F-- :r--r-•�' � � I I <br /> A_.�_� --L t- <br /> --_ <br /> -7 --f--r - <br /> -r- <br /> t--J41- <br /> : <br /> I I <br /> ON)T 7T <br /> F): TMF,NTSF. 'l.Y _ <br /> APPLICATION ACCEPTED <br /> Al:-j I lVD ARE -EMPLOYEE 11)Ijb DIM IC7_" T'LON� <br /> LNSPGCIED BY: DATE; I��/ PERMR FINALb'YES DATE: -__ INSPECTOR: <br /> COMMENTS: <br /> I <br /> PE CODE SC INIFO AMOUNT HECKA 'H RECEIVED DATE MvpICER SVDCIW <br /> REMITTED By <br /> 32c," ►�5�0 IZ �, �;� , <br /> Rcvlseoalaal i I <br /> I <br />