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Vx ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468 3420 <br /> NoN-REFu LE PE IT ALL eD-7166597FOR INSPECTIONSEXPIRES 1 AR FROM ATE ISSUED <br /> --JOB ADDRESS -CI - -- -- - Ay <br /> CROSSSTHE _... .____.. __.- APN_ _L ____ -.___._-__—.-PARCEL SIZE o <br /> OWNER NAM <br /> _ _.._ - +- <br /> OWNER ADDRESS - j[ Cm/STATE/ZIP <br /> CONTRACTOR ' _- _ _ PHONE - <br /> 2115 <br /> CONTRACTOR AD[t11ESS _..... -_-.- _--- _ CITYISTATF/ZV_ --- <br /> LICENSE Iat IC-Q. ui iC-3S OTHER ,_ NUMBER __EXPIRATION DATE. <br /> LE -- <br /> WATER TAB//// DlPitl: ft GEOORAPHICAL INFORMATION: Coordinates X----_-- Y PERC TEST -------- <br /> _ �— <br /> •� BtRLDING PERMIT# <br /> YVPE OF WOftK- New IMYALLAT REPAIRJADpRK1N O ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT AAvI! OUT-OF-SERVICE SEPTIC SVSTEIN ❑ DESTRUCTION <br /> INSTALLATION WILL$11I lTE: 1K ReweNCE i 1 COMMERCIAL 0 OTHER.-- <br /> NUMBER OR UVM t MM-�- NuMW OF BEDROOMS: NitiallipR OF EMPLOYEES: <br /> (3 SEPTIC TANK TYPE/MFG_.-_.. -._..__._._— CAPACITY gal N OF COMPARTMENT S <br /> LQ GREASE TRAP TYPE/MFG —__._-.._._ -__.__.__ CAPACITY gal N OF COMPARTMENTS_ <br /> DwArK:E TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE <br /> 0 LIFT STATION SIZE _._TYPE OF PUMP, _,O PKQTX PLANT O SANDt9R.SWMATOR(ENCLOSED SYSTEM) <br /> U LEACH LINES I LEACHING CHAMBERS p OF LINES LENGTH OF LINES _ /t <br /> DISTANCE TO NEAREST WELL _ it FOUNDATION it. PROPERTY LINE II <br /> J FILTER BED WIDTH- ft LENGTH.__— it DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYUNE ft <br /> J MOUNDED WIDTH ft LENGTH It OEM _ ft <br /> DISTANCE TONEAREST WELL _ft FOUNDATION ft PROPERTY LINE IT <br /> .1 SUMPS WIDTH-___-. it LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE f! <br /> J DISPOSAL PONDS WIDTH_.­-_.._It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL-_._--,- It FOUNDATION _ ___It PROPERTY LINE,-_.._.�__----_. fl <br /> U SEEPAGE PITS NUMBPA _ WIDTH -It DEPTH_ - R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION___ ft PROPERTY LINE_ __.k <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQURI COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> REQUIRED FOR MF C ONS- 3-7 7 <br /> SIGNED ThAIL&W DATE --_ <br /> ) <br /> L <br /> F <br /> B DEPARTMENT LS <br /> Application Incepted _ Date_ AT <br /> Area Employee fDN_ L�i I�IL <br /> Final Inspection B ` Date_ _ 17 SPEC AL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft:___ .� Soil racier: ___ — <br /> 4JMENTS _ r fiS <br /> PE SC Racaiwd CtleckAi3 Amount ParmW <br /> Cade _INFO ash Remftbd Date Service Roguest N Mvo N <br /> slot <br /> •+:-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> ,:4 7? <br />