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I�✓ <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT I M E.HAZELTON AVENUE-STOCKTON CA 85265-(2D9)468-3420 <br /> NON-REFUNDABLE PERMIT Q _� CALyL�209 9�5j3,--7697F�ORINSP CnOIrS EXPIRE <br /> S <br /> 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS, -- ✓ Sd.:. �1=--•Y +j�J-J•7&CmT11P_g1�-7`';G Wr tt. <br /> CROSS STREET <br /> r APN ✓—.........._.— PARCEL SaE <br /> OWNERNAME ' _42a( — <br /> PHONE �X'-•'S � 1 '1_ . <br /> OWNER ADDRESS l� II�d — r•17YlSTATE/Z1P_/ _._......._..f.:..�.�.s"..1'j .._. <br /> CONTRACTOR t_Ke._'S <lQ<L. ,"}� .a.L' PHONE�I.,J4�r _jr <br /> CONTRACTOR ADDRESS ,} ..__—.__. .5.. <br /> LICENSE 'r...C-42 I-, C-36 OTHER - ," _ a <br /> ...___._.._..._.. NUMHER � �EXPIRATION DATE___ ��� <br /> ) y''�yy1 <br /> WATER TABLE DEPTm.-4 "-6Z✓ It GEOGRAPHICAL INFORMATION: Coordinates X......_..._.............__ .___,_ Y <br /> PERC TEST # —� BUILDING PERMIT LAND USE APPLICATION# _. <br /> TYPE OF WORK: NEW INSTALLATION .. REPAIR/ADDRION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: J;eheswENc£ 1. COMMERCIAL OTHER—_,-- _ ___ <br /> NUMBER OF LIVINGUNITS: -j NUMBER OF BEDROOMS: )/ NUMBER OF EMPLOYEES:� <br /> 41--SEPTIC TANK TYPE/MFGri L CAPACITY I tP 5,> gal #OF COMPARTMENTS,gh <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY _....... gat #OF COMPARTMENTTS_,_____—.—_- <br /> DISTANCE TO NEAREST: WELL—ms's"-' /Va ft FOUNCATION 13) - it PROPERTY LINE . . 7R' <br /> R, ft <br /> Cl LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LE <br /> K LEACH LINES LEACHING CHAMBERS_ #OF LINES Lju LENGTH OF LINES_ �t ft <br /> DISTANCE TO NEAREST WELL FOUNDATION_.,eft PROPERTY LINE ft <br /> ❑ FILTER BED MOTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL—„..._....—it FOUNDATION ,ft PROPERTY LINE_ .._.__........._f1 <br /> Q MOUNDED WIDTH.___—. ft LENGTH �.— ft DEPTH,—_.__....... it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE ft <br /> ;Q <br /> SUMPS WIDTH It LENGTH _ ft DEPTH ._.�It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE___ it <br /> Cl DISPOSAL PONDS WIDTH it LENGTH it DEPTH ft <br /> DISTANCE To NEAREST WELLft FOUNDATION .—,—ft PROPERTY LINE,,.._._....____,,,_.—,_..ft <br /> ❑ SEEPAGEP6t'3 NUMeER__ WIDTH ft DEPTH— _.------- it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN£ it <br /> t HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND.THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> MINIMUM 24HOUR ADVANCENOTICE REQUIRED FOR INSPEC77ONS-PLEASE CALL gffi 953-7697 <br /> STONED —_. TITLEljt <br /> 4 _ DATE l J <br /> I � <br /> i <br /> I <br /> I 1 <br /> { ,S <br /> A <br /> EPARTME T"SE ON Y <br /> UCT9tlGtii fl.Ca tftuE �” Y��..._ m, <br /> p .+ ,..TJX, — Arsa.,µ 77 <br /> Final inspection B srr y y ^Y Date l' " <br /> ! SPECIAL PERMIT-Approved by <br /> Character of Sail th of 3 FL•._ P4Sump Soil Character: ____.... <br /> COMMENTS- -ti <br /> PE SC Received k Amount Permit/ <br /> Code INFO as arnitted Date Service Request III <br /> Invoice# Permit ID1t <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4ANhI <br />