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T,41( 5Ct, 6'(7-16 1)'71,1 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS )n14 q{ I ..—�sKL _ CRY/ZtP 2 <br /> _ 'faLl�t� S�/. _ <br /> CROSS STREET V^_C y_-444-1- <br /> I.I1<r -_ __ /_� �APN Q/I�)b!�Qf' !�w .3 —y_J��v7 PARCEL SIZE ! / _ a <br /> OWNER NAME-f--1-Y[XlL�4�� <br /> OWNER ADDRESS CITY/STATEMPP — n <br /> CONTRACTOR_3'f/1�1 APHONE—j.�k�S L7 -l�Lt r _.._- .- <br /> CONTRACTOR ADDRESS —�'� c3�� (.!�'o _-/'.l...._ .-CITY/STATE/ZIP c y SL cry-I3 <br /> LICENSE FI! C-42 E! .0-36 OTHER NUMBER 4a25;it_EXPIRATION DATE-C;;10. p -11- <br /> 1 �q I <br /> WATER TABLE DEPTH: - 1..�3/_it GEOGRAPHICAL INFORMATION: Coordinate$ X <br /> ❑ PERC TEST It BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ✓ REPAIR/ADDRION ENGINEER DESIGNED/ALTERNATIVE <br /> X REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: L�SIDENCE 1) COMMERCIAL A OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_- NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG �-L _ CAPACITY bi7._. _ gal #OF COMPARTMENTS__ <br /> O GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 1_„ it FOUNnATION_ it PROPERTY LINE ��I 1l <br /> �❑ LIFT STATION SIZE TYPE OF PUMP___ .--. 13PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> UY LEACH LINES I LEACHING CHAMBERS —___ #OFLINES_�� LENGTH OFLINES R <br /> - I <br /> DISTANCE TO NEAREST WELL S! - it FOUNDATION Lf%_'—.ft PROPERTYUNE L1.A1 it <br /> ❑ FILTER BED WIDTH it LENGTH_ fl DEPTH it <br /> DISTANCE TO NEAREST WELL__ __ it FOUNDATION it PROPERTYUNE it <br /> ❑ MOUNDED WIDTH _it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL _ fl FOUNDATION it PROPERTY LINE fl <br /> ❑ SUMPS WIDTH __-it LENGTH,_._..._ fl DEPni it <br /> DISTANCE TO NEAREST WELLIt ft7UNDATiON fl PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH 1t LENGTH__ __ __, _ fl DEPTH it <br /> DISTANCE To NEAREST WELL — it FOUNDATION it PROPERTY UNE _it <br /> P�-SkEPAGE PITS NUMBER LA--- WIDTHit DEPTH — it <br /> DISTANCE TO NEAREST WELL_ja%{ it rouNoATION +,-!fTft PROPERTY UNE L{,71 it <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNEDTITLE. C O/1�E_CSd. a.f' - -- DATEG+-- <br /> F- <br /> 2 <br /> �QW <br /> •2 <br /> -T- ; ZW6 <br /> - _ — :D C) <br /> L — aj2 <br /> � W <br /> . EPARTMENTUS NLY r' I <br /> Application Accepted nee-W17/1&--- Area � QOl EmployeelD# Q <br /> Final Inspection By._n ���.)c 0.rJ.� Date._7. 6Q SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PittSump Soil Character: <br /> COMMENTS 01-D LA2T --- <br /> PE Sc Received Checklf/ Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Immice# Permit ID# <br /> 4240 1-71(y 24z !_ �tIDW11Q P - <br /> 42-01 ONSI TF WASTEWATER TRTMNT SYSTEM PERMIT <br /> 424/12 <br />