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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> • SAN JJAcum COUNTY ENVIRONMLNTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL(209)9553.7697FOR INSPEC17ONS _EXPIRES T YEAR FROM DATE ISSUED <br /> JOB ADORFS9 -7174c-a r-rh aIt, Qr. cmOmr,..�/�4Ly. <br /> +/Iy / n <br /> CROSS STREET .., LYw�ETTF,Vv APN.hS3�f—/IJ� '�6 PARCELSI e <br /> OWNERNAME G�{T R))/ �� � V IyN� � _�[/TA PHONE <br /> OWNER ADDRESS <br /> �y 'J /T �_ �L �JLy♦!=._ - CITYISTATEMP <br /> CONTRACTOR . P_S _ PNONf <br /> CONTRACTORADDRES9 P_`� • &7c <br /> LICENSE IJ C42 U �C-366 OTHER_ _ __ NUMBER d3 __EKPWAMDN DATE ✓L/�� <br /> WATER TABLE DEPTH: �/J// 'jam It GEOGRAPHICALINFODMATIDN: Coordlnstu X ..._ Y_ <br /> U PERCTEST A BUILDING PERMIT# — L O/ USE APPLICATION# <br /> TYPE OF WORK: X NEW INSTALLATION REPMRIADDNION ENGINEERDESOG IALME MVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 17 RESWENCE Ll CoMMEnclu �.a ORIER <br /> y NDMBER OF LIVWG UNITS: _ NuMemoFBEORODLIS: % �l NUMBEROFEMPLOYEFS:_ <br /> yi. SEPTICTANK TVPENFO _ L CAPACITY V gat POFCOMPARTMENTs._. Z- <br /> ❑ GREASETRAP TVPE/MFG / y CAPACITY Dal SOF COMPARTMENTS.____ <br /> DISTANCETONEAREST: WELL/S!/f N FOOODATION�5.. _ It PROPERTYLINE _/ t/ O R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PUNT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS _ pOF LINES LENGTHOF-UNES it <br /> DISTANCE TO NEAREST WELL TDO K FOUNOAIION_TLV 1_R PROIk[UYDNE /00 R <br /> ❑ FILTERBED WIDTH—ft LENDIH h DEPIN 11 <br /> DISTANCE TO NEAREST WELL 0 MUNDA11M____R PROPERTYDNE K <br /> ❑ MOUNDED WIDTH—11 LENGTH_.._ ___ __ K DEPTH _ R <br /> DISTANCE TO NEAREST WELL it FOUNDAIKMN K PROPERTYUNE 0 <br /> ❑ SUMPS WIDM h LENGTN h DEPTH L.�T�0 <br /> DISTANCE To NEAREST WELL h FOUNDATION 0 PROPERTYDNE. �"f-`1YkN <br /> ❑ DISPOSAL PONDS WIDTH _h LENGTH 11 DEPTH en>,I W4 V _h <br /> OISTNNCETONEAREST WELL0 ilouwATKXN h 1'fK)PEIi Yl NE0 11 <br /> ❑ SEEPAGE PITS NUMBER Wlom _ _ _ ___II DEPTH HC�EEE�NVIIIO'� U/y II <br /> DISTANCE TO NEAREST WELL _,. It FOUWAIKMJ 0 PIUN't I11YUNEHaE�,It <br /> I 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-769 <br /> SIGNED TITLE DATE��� /� <br /> `� br/gY;Si4:NAJ WM6 1{IrRE- <br /> I ❑ pQ4fEAF� ProppyJNew Tu);le�{rrn6 scl c�LCA6 ' <br /> GkrAja Y <br /> I sY' <br /> 5eA>;A dWNA s 3 r`a �v <br /> 1 1 SNF <br /> w�a� ' m�}caRThE2 (J2, L <br /> Applici on Accepted B _ _ Date �/_ Area _ Employee IOa �7 <br /> Final Inspection OV.� _. _ <br /> ate <br /> a/jU /�J _ 17 SPECIA�MIT-Applovetl Ey <br /> Chameler o/Soil td'Uo 0l7 Ft: Pl p Soll Cherecler. <br /> COMMENTS <br /> /N Ewe ReElLTr N <br /> PE SC RaLN:ivetl Amount Date PermlV Invoice if Permit JOIN <br /> Coda INFO B Caeh Remitted Service R. DaatE <br /> f�� f ¢� al y 1G1%907,L- I - I <br /> 42-01 ONSITE WASTEWATER TnTMNT SYSTEM PERMIT <br /> 4Ri/12 <br />