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4100- //yc, <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT D q-,O <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3te FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PE IT CALL 109 953-7697 FOR INSPECTIONN EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS <br /> CITYIZIP <br /> CROSS SSREEET(J�/��//�/ _ APN D _O�aO- O,S PARCELSIZE a, <br /> OWNER <br /> �' � Li <br /> OWNER ADDRESS It CITY/SFATFILIP L <br /> CONTRACTOR t PHONE <br /> CONTRACTOR ADDRESS CRY/STATE/ZAP <br /> LICENSE -42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEocRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST 8 BUILDING PERMIT#&9 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENgNEER DESIGNED(ALTERNATIVEtzzy <br /> ❑ REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: REStDF2tCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ^-An�, NUMBER OF BEDROOMS: �/JC NUMBER OF EMT[AYEFS: t <br /> SEPTIC TANK TYPE/MFd:!WlkC ��� CAPACITY _ OO gal #OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG __ CAPACITY gat #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL�_ <br /> ft FOUNDATION __ ft PROPERTY LME J ft <br /> ❑ LIFT STATION S12E TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) TZ <br /> PKL— OF LENGTH OF LINES !—_ft <br /> LEACH LINES LEACHING CHAMBERS # LINES IJ ft <br /> It FOUNDATION _�60 ft PROPERTY LINE <br /> DlsrwnCETONEAREST WELL ft <br /> WIDTH fl LENGTH ft DEPTH ---- <br /> ❑ FILTER BED ft <br /> ft FOUNDATION ft PROPERTY LINE <br /> DISTANCE TO NEAREST WELL ft <br /> (3MOUNDED WIDTH ft LENGTH fl DEPTH ft <br /> ft FOUNDATION fl PROPERTY LINE <br /> DISTANCE TO NEAREST WELL R <br /> O SUMPS wlDn+ ft LENGTH it DEPTH <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> DtSTwNCE TO NEwREST WELL fl <br /> ft LENGTH ft DEPTH <br /> ❑ DISPOSAL PONDS WIDTH fl PROPERTY LINE ft <br /> DISTANCETONEARuT WELL ft FOUNDATION _ Y LINE ft <br /> DEPTH ft <br /> 7 <br /> R <br /> BR <br /> SEEPAGE PITS NUMBwoTR <br /> DISTANCE TO NEAREST WELL 1 ' .�ft FOUNDATION�ft PROPERT7�, <br /> 1 HEREBY CERTIFY THAT f HAVE <br /> ORDINANCAES.STATE LAWS ANDIRU ES AND REGULAON AND THE WORK TIONS OF SAN JOAQU N COUNTYLL BE DONE IN ACCORDANCE W WITH SAN JQAQUIN COUNTY <br /> NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 e-/� <br /> X D TITLE p� � DATE <br /> SIGNED <br /> O M <br /> DEPARTMENT U E NLY F-tap"m ID# � ��� 9� <br /> �.� Date -7 D.$ Area <br /> Appliotioa AaeptedDate '�� ❑ SPECIAL <br /> PERMIT-Approved by <br /> Final Insptctis y PiUSump Sail Character: <br /> Character of 1 t pth 3 Ft: 3 i.dam <br /> COMMENTS c2 a <br /> e 6'`"� .. / PeradU /-— invoke# Pcradt ID# <br /> Aaauuat <br /> PE Received hoc Remitted t Servke uest# <br /> code INFO B zo.>D r L�42112-' <br /> y2•IS 1 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02.001 <br /> IZ22/2DD3 <br />