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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOACLAN COUNT'EKWRONM04TAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4663420 <br /> KION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE 133UED <br /> JOB ADDRIM Z4O1 ( C � 1>0C>pS e S � n <br /> Cwa, EC. L-oJ <br /> SS S � <br /> CROTREET �C!}L ON 13" CLL A <br /> O 7 APN �O�- '�0 -l�� PARCEL SIZE �L3� ''` <br /> GUNNER NAME D C,%j tjI S 130(LBS PHONE S3( - 3 T 4 <br /> OWNER ADDRESS P. IqZ CITYISTATEMp CSG/t Lo^�t CA `1320 <br /> CONTRACTORS 1.A V C)AK-- G EyE pN.�(LO�YN F,-I�.fi AL_ PHONE 3(o 9-Li3, p <br /> CONTRACTOR ADDRESS V T ��• •`�' 1 CITYISTATEIZIP (•'O1�(' <br /> LICENSE QC-42 QC-36 OTHER Nummin EXPRATIONDATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL WORAMTWN: Coordinates X Y <br /> )( PERC TEST 97:::]Z7777 i BUILDING PERMIT*----_----- LAND USE APPLICATION A-- <br /> TYPE OF WORK: D NEW INSTALLATION ❑ REPAMIADOTON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACB®NT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ CONOMMAL ❑ OTHER <br /> NUMBER OF LARNG UNITS: NUMBER OF BEDROOR: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal NOF COMPARTUENTS__ <br /> ❑ GREASE TRAP TYPEIMFG__--- ------------_-- CAPACrTY___----__ gal KOFCOwARTMENiS---- <br /> DISTANCE TO NEAREST. WELL__-_— If FOUNDATION ___ R PROPERTY LIVE ft <br /> O LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS NNoF LINES LENGTH OF LIES _ _If <br /> DISTANCE TO NEAREST WELL-----It FOUNDATION—___R PROPERTY LINE ft <br /> ❑ FILTER BED WoTH If LENGTH—_--A ___ft DEPTH If <br /> DISTANCE TO NEAREST WELLft FOUNDATION _ft PROPERTY LINE It <br /> ❑ MOUNDED WoTH _It LENGTH _ —^_ft DEPTH_ It <br /> DISTANCE TO NEAREST WELL __ft FOUNDATION ___2 PROPERTY LIVE It <br /> ❑ SUMPS WNm+_—___--R LENGTH _ft DEPTH --_It <br /> DISTANCETONEAAEST WELL__It FOUNDATION ___ft PROPERTY LIE If <br /> ❑ DISPOSAL PONDS Wum R LENGTH--- It DEPTH -_ft <br /> DISTANCETO NEAREST WELL—_-R FOUNDATION____It PROPERTY LIEft <br /> ❑ SEEPAGE PITS Nulma Vft_ _ft DEPTH— If <br /> DISTANCE TO NEAREST WELL R FOUNDATION_ It PROPERTY LIE_ ft <br /> HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQU IN COUNTY OROWANCES. <br /> STATE LAVA AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY• <br /> MU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE C tJ'�!✓I..Tl4�. T PATE - ) <br /> !4n <br /> s <br /> e ro4� <br /> 0-` <br /> Jar 6S <br /> y <br /> w <br /> A 6 <br /> Q O <br /> QP <br /> �• A <br /> O = <br /> • e <br /> T N <br /> O Employee IDs <br /> Applicatlon ACCepted By 1� ' i1Date <br /> Final Inspection By Date_ __ ❑ SPECIAL PERMIT-Approved by <br /> Character of Sod to Depth of S Ft poSump Sed Cheraeter: <br /> COMMENTS NT <br /> -- - VED <br /> PE SC ;Reced heelot/ Amount *71+ <br /> Service R it <br /> rmw Invoices Per 20 4 <br /> Code Iwo Re-kid <br /> zz 5�1 3{3 $Z�0 JOAQUI COUNTY <br /> EN1l ENTAL <br /> ONSITE WASTEWATER TRVAGA" nARTMENT <br /> 4241 <br /> i0l"7 <br />