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I <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JDAgUaa COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 18W E.HAZELTON AVENUE-STOCKTON CA 95M•(209)498-3420 <br /> AEON-REFUNDABLE PeftmIT CALL 09 953-7S97FoR1NsPEcmNS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS }�CITYITIP^� <br /> CRGSSSTREEY / APN S36a D� PA=F-L SIVE az <br /> pvaJER I�EAAFE GII <br /> 3_ { PHflNe <br /> OWNERADDRESS 3.S 5, 6✓ 1&10kde- L-cnP C11Y1STATE121P <br /> CONTRACTORPrIONE <br /> CONTRACTOR ADDRESS lj=�'�-C f�C CITYIS <br /> TATE(LIP <br /> LICENSE ❑)(C-42 C DC'-M OTHER NUMBER EupgAYIDN DATE_ <br /> WATER TABLE DE fel: /`-' ft GEDGRAPHICILL INFORMATION: CDordlnates X Y <br /> PERC TEST BUDMING PERMIT# j LAND USE APPLICATioN# ; <br /> TYPE OF W604 NEW INSTALLATION Cl Rep ADDmo" ❑ ENGINEER DESIGIIED IALTERNATIVE <br /> ❑ REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM C 1).TRUCTxw <br /> INSTALLATION WILL SERVE: Q RESIDENCE C1 ComMFRCIAL IX OTHER i - fI Il st <br /> NUMBER OF Limt;UNITS._ NUMBER OF BEDROOMS:_ NumBER OF MPLOYEES: <br /> I1!� SEPTIC TANK TYPdMFG CAPACITY gal #OF COMPARTMENTS ,I' � <br /> U GREASE TRAP TYPE"FG CAPAc ry <br /> gal #DF COMPARTMENTS <br /> DISTANCE TO NEARF01: WELL^,lj92.f' ft FOUNDATION ft PROPERTY LME 5 R <br /> L) LIFT STATION SIZE,TYPE OF PUMP_p PKG TX PLANT 0 SAND OIL SEPARATOR.(ENCLOSED SYSTEM) <br /> Q� LEACH LINES G LEACHING CHAMBERS #OFLNESLENGTHOFLINES J:r* fl <br /> DISTANCETONEAREST WELL J„SV, ft FOUNDATION fI PROPSRTYLPNE _ -� ft <br /> ❑ FILTER SED WIDTH ft LENGTH it DEPTH ft <br /> DISTAN CE To NEAREST WELL tl FOUNOATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTR h LENGTH R DEPTH R <br /> DISTANCE YO NEAkEST WELL ft FOUNOATION (I PROPERTY LINE it <br /> IJ SUMPS Wlrrm R LENGTH It DEPTH A <br /> DISTANCE TO NEAREST WELT It FOUNDATION R PROPERTY LINE R <br /> DISPOSALPONDS WiDTH R LENGTH R DEPTH R <br /> DISTANCE To NEAREST WELL It F4LNOATON R PROPERTY UNE R <br /> SEEPAGE PITS NumsER -? WIDTH_ i. G R DEFRi,.19� Il <br /> DETANC E To NEAREST WELL _ It FOUNDATION_ p8r R PROPERTY U14E!a-� R <br /> I HEREBY CERTIFY THAT I HAVE PR EPAREO THIS AP PLICATION AND T'HE WORN WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORMNA1ICES, <br /> STATE LAWS AND RULES AND REGULAT IONS OF SAN JOA OLI IN Cd UNITY- <br /> mfm1mum 48 H AP VAN E NOTICE REQUIRED FOR INSPECT! -PLEASE CALL 209 953-7687 <br /> SIGNED TITLE e;W46CA4C DATE <br /> JJ DEPARTMENT USE ONLY <br /> Application Accepted By Data JZLozOiArea I Employee IDN <br /> FilialInspection$y ,,.,:[(>� �� ?_ Da1e�jj7:jjZPY.L LI SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3I FFt,; Pit sump Sotl Characwr: <br /> COMMENTS �uilCt�1>7C_ t <br /> Code 91 8 ReeNvad tiArnau d Date PNMW Service Ra uesS fl Invoice 0 Famtk IDii <br /> ,2s �2 ZfR "+ <br /> 42-G 1 ONS ITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114M$ <br />