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42.0 INanE WASTEWA I Eit TRTMNI SYSTEM PERMIT <br />Application Acc <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft:___ <br />COMMENTS F <br />Data <br />1 PE Received ! C <br />Code By ' ate t Invoice I <br />1 MI I ii 37 <br />L 3 I <br />414/12 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SaJOAOUN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzEtTON AVENUE - STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADORESS _i_t_4‘tA ,%4 iEv•--) C,„ <br />CROSS STREET N.4A'6,4,;_i" AP N 0 I- <br />OWNER NAME tt"4 L40.3-1 2- PHONE ZOC) " ‘I -2•16 <br />OWNER ADDRESS _ _ i51"177-18,4")f._117 -WY/STATE/ZIP --eaterilLerifl, <br />CONTRACTOR V4es cowl 6/.4,4 11:,,c PHostE <br />CONTRACTOR ADDRESS Vil'Alltj t CETY/STATEMP L-001 CA 4.1'91.3 <br />LiCENSE C-42 1. .C-36 OTHER NUMBER est‘si EXPIRATION DATE Z-4) <br />PARCEL SIZE 42 I <br />WATER TABLE DEPTH: <br />I PE RC TEST _ _ _____ <br />TYPE OF WORK: NEw WSTALLA <br />REPLACEMENT <br />It GEOGRAPISCAI. INFORMATION:Coordinates X _ <br />G P LAND USE A PLICATION <br />REPAI <br />MT-OF-SERVICE SEPTiC SYSTEM <br />ENGINEER DESKINED/ALTERNAnve <br />r— <br />INSTALLATION WILL SERVE: RESIDENCE Commanct OTHER <br /> <br />NumBER OF LIVING, UNITS: „ „ I NUMBER Of BEDROOMS:NUMBER OF EMPLOYEES:, <br />Z.. SEPTIC TANK TYPE/MEG _?•it'L CAPACITY 11142. gal 4 of COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal * OF COMPARTMENTS._ <br />,„.. • , <br />DISTANCE TO NEAREST: WELL 11 EOUNDATiON kW .., ft PROPERTY LINE ____________ <br />UFT STATION SIZE ____ TYPE OF PUMP „_ 0 PEG TX PLANT O SAND 011. SEPARATOR (ENCLOSED SYSTEM) <br />El LEACH LINES A LEACHING CHAMBERS i 1/41C I k 1 I iVr4 / s OF LINES $ LENGTH OF UNES <br />Yft FOUNDADON , ft PROPERTY UNE DISTANCE TO NEAREST wat, .1. 1 <br />FILTER BED W11.1n1 „ ft LENGTH It DEPTH _ <br /> <br />PROPEREY UNE It <br />LI MOUNDED Marti rn It LENGTH ft <br />DISTANCE TO NEAREST .......ft <br />2 SUMPS Wami ft LENGTH It ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISPOSAL PO S WIDTH ft LENGTH _ ft DEPTH <br />DISTANCE TO NEAREST WEU, ft FOUNDAINON ft PROPERTY LINE <br />SEEPAGE PITS NumeEn „ 3 Mom, 11:„/ ___, _ _____ _ft DEPTH <br />DISTANCE TO NEAREST WELL 2.-.Q.E"? ft FOUNDATION IB, _It PROPERTY LINE <br />DISTANCE TO NEAREST WELL ft VANDAtiON <br />DEPTH <br />PROPERTY UNE _ <br />HEREBY CERTIFY THAT I HAVE PREPARt.:D THIS APPUCATION AND THE WORK WA, RE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOACIIIN COUNTY. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALI- 009)953-7697 <br />SIGNED TITLE_ L_0(.041„, DATE xi -