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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE-STOCKTON CA 05205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY2iP <br /> CROSS STREET s , Ae, pu<- APN 0 2 7 3 /V'S� .-PARCELSIZE <br /> OWNER NAME G= PHONEY7y / <br /> OWNERAOORESS /1�" f['I�. �'J ('�. CrrY/STATE(2' Sf� �. (•.,I'; Ct', �5�.� / <br /> CONTRACTOR GC_.YI!%L►�)Z,,JJ1Aw Sc's'� �.. PHONE <br /> CONTRACTOR ADDRESS 3�7� " `"'� I"////C- (,0;—' CrTY/STATE,1P <br /> LICENSE -A-42 J C-6 OTHER NUMBER [ 7 EXPIRATION DATE <br /> I � <br /> WATER TABLE DEPTH: ,�' ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERM IT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REP ljkls.S ENGINEER DESIGNED/ALTERNATr <br /> REPLACEMENTOUT-OFSERVICESEPTIC SYSTEM X DESTRUCTION �� h' 1L, L� <br /> j INSTALLATION WILL SERVE: ;F,RESIDENCE ❑ COMMERCIAL cC r e I r. OTHER <br /> 1 NUMBER OF LIVING UNITS: NumaER OF BEDROOMS:i2 i C J.C ;1)(„ NurIBER OF EA®LOYEES: <br /> SEPTICTANK TYPEIMFG T.Ai r— f�+/`I CAPACITY /Z gal #OFGowARTMENTS� <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY 7 gal #OF COMPARTMENTS <br /> DISTANCETONFAREST: WELL I ft FOUNDATION /�� ft PROPERTYLINE 56, ft <br /> ❑ UFTSTATION SIZE,�.. TYPE OF PUMP 0 PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES _ LEACHING CHAMBERS #OF LINES_ _ LENGTH OF LINES_ J It <br /> DISTANCE TO NEAREST WELL_ SZJ'T_ft FOUNDATION zs, ft PROPERTY LINE /�. ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NAAR2S' WELL R FOUNDATION ft PROPERTY LINE R <br /> �p SUMPS wuTE _ ' ' _ ft LENGTH I ft DEPTH_ — _It <br /> DISTANCE TO NEAREST Y"�" I _ft FOUNDATION ft PROPERTYONE _ _R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NULRWR WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL OF DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE N 77CE R A 2 953-769 <br /> SIGNED _. _ .-._ TITLE ,--'— DATE <br /> i <br /> ( 1 <br /> � I <br /> iJ�11R IIS fi 1 <br /> SD _ � II II PgyM <br /> RFC, � <br /> i VF <br /> 1 AY 0611r) D <br /> 20 <br /> i E I AQUIN 20 <br /> i I I ,RD Pg IV7 C <br /> 1 i I I NT <br /> I <br /> Application Accepted Date ` �' z N" Y .Area /,� �/�� Employee ID# p� <br /> Final Inspection By Date 'p, /SPECIAL PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft: Pfvsump Soil Cter: <br /> COMMENTS 01170 ", <br /> , fCC:250)qPiYIPJ;�� XISf11IC S S)E {Y1 o.rl p�'15f�11 ' �<;T <br /> � 4 I N <br /> PE SC Received Check#/ Amounl Permit/ <br /> Code INFO B Cash. Remitted Date Service R uest# Invoice Permit ID# <br /> Q01oB20I <br /> 42-01 ONSITE WASTEWATER TRTk1NIT SYSTEM PERMIT <br /> 4,141118 <br />