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� rS ✓ <br /> + ,�» ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 61 SN <br /> CnY/ZIP <br /> E. i_01V�i� Czoc�, APN <br /> CROSS STREET rr�I� 1r�/�. �/)�yr�� `r_`A Mal <br /> nL �` �.�,//jj 1 ,^^ �P�AyYR�CEL SIZEVrl <br /> OWNER NAME�ll�1�l�liU'�/L"1 1` M�1`UL"A,J UL ) .lam �1..• HONE'�\ �— 4 <br /> OWNERADDRESCS ^ny��� �,�fCITYISTATE/Z�IPr� C/ V CN I ci' <br /> ci'5y <br /> CONTRACTOR ` 1�/�t+y/�y�}v�!/7�("U��V V\\ \1 O� V Y� ,t X A r N i�Y U, PHONE t�1T 1 1 -`�Ol+��-`�/ �/�ll�^/ `r1 A G <br /> CONTRACTOR ADDRESS `-' \'��(�''M,`/��� ° 4 R P^ CITY/STATE/ZIP V��\�]]T So ` `C `� `S? <br /> LICENSE '.i C-42 LJ. C36 OTHERI�/ N, I NUMBER 8`��1 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> IJ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: Ll RESIDENCE J COMMERCIAL ❑J OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697/r <br /> SIGNED TITLE_O�'L,S' DATE <br /> R���FND' <br /> JUN <br /> F T tj <br /> p�pMFNTAj tY <br /> '`1 RTMENT <br /> D PARTME T qU�s <br /> Application Accepted Date Area Employee ID# <br /> Final Inspection By Date ❑ SPE IAL PERM -Approved by <br /> Character of Soil of 3 t. Pit umD 6a"haracter: <br /> COM N S ��< <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Ely, ash Remitted Service Request# <br /> t1 •Z <br /> 44.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />