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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)468.3420 <br /> PION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jae ADDRESS E•rEIC-14T p/Y��I L E ISD• �y cm{,JmP l-gO b 97--a-6+0 <br /> CROSS STREET rM�,AG,�.�E t�P'J V Ems•-1'-�t•�+. APN O r I ` �J PARCCELL SIZE 5- <br /> r5- • I <br /> OWNER NAME "� {�• S tt+RS 1 �'1 PHONE +z3- T W I! , <br /> OWNER ADDRESS 3��5 El�t►7 MILE 117. cm2l <br /> isrA17P <br /> y f�—r <br /> CONmACTOR L4VE^ OAit. Crf,OEN�.1I�.aeT►I-I1°��I��` PHONE 346"x, <br /> CONTRACTOR ADDRESS O� CU� .7 7 . CITY/STAMTr 1.,ot0l rC.A <br /> LICENSE QC-42 EDC-36 OTHER NUMaER EXPOATIONDATE <br /> I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> —TEST i-� BUILDING P@RMIT1�_--______-__LAND USE APPLICATION IR.pr_S s2-QASl-I.._ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADOITION C Ewawok DESIGNED IALTERNAWE <br /> D REPLACEM NT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RERIDEWE r1 COMMERCIAL ❑ OTHER j <br /> ( NUMBER OF LYING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> © SEPTIC TANK TYPEIMFc---.-�.------------- CAPACm -- gal #OF COMPARTMENTS __- <br /> ❑ GREASE TRAP TYPENFc CAPACm-__-_-_ gal #OF COM/PARTMENTS_.- <br /> DIaTANCE TO NEAREST. WELL__----_ ft FOUNDATION_ R PROPERTY LANE- ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> U LEACH LINES ❑ LEACHING CHAMBERS #OF LINEs LENGTH OF LINES_-___--_.-_ft <br /> - DISTANCE TO NEAREST WELL—___It FOUNDATION--- It PROPERTY LIE_-_-.- _it i <br /> y <br /> ❑ FILTER BED WIDTH_-------ft LENGTH_-----_-�.---_ft DEPTH_-___T—'_-------It <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION_`-_ft PROPERTY LINE_ ._ft <br /> ❑ MOUNDED WerrH—_-----ft LFwTH_-, ...__..____._ft DEPTH----------ft <br /> DISTANCETONEAREST WELLR FOUNDATION-_--___-__ft PROPERTY LP£_--_--_it <br /> U SUMPS WSOTH_-^------ft LENGTH------__-----ft DEPTH_--J„_-��_.-ft <br /> DISTANCE TO NEAREST WELL1t FOUNDATION _-,.---R PROPERTY CINE_------_ft <br /> ❑ DISPOSAL PONDS WmH.--_,-------it LENGTH—_— ------_R OCCPTH _—.--_.---.—_ft <br /> DISTANCE TO NEAREST WELL___—_.ft FOUNDATION_..- R PROPERTY LNE---___It <br /> ❑ SEEPAGE PITS NuMEre WIDTH--- --------tt DEPTH------------it <br /> .. DISTANCE TO NEAREST WELL--�-R FOUNDATION---__-ft PROPERTY LAE—__ —it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE NTH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULE!AND RfiGuLATIONS OF SAN JOAQUIN COUNTY. j111 <br /> �NI M1J,17134 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS.PLEASE CALL(209)953-7697 <br /> SIGNED /j TITLE Cot-JOV.`AWT DATE t 0 '� I <br /> 7— <br /> I <br /> t <br /> I I <br /> I <br /> PAYMENT <br /> r I 0� c, <br /> 1 7771 1 1 i AN JOAQUIN COUNTY <br /> ENVIROMENTAL <br /> IEALI H 0EPAR WENT <br /> � � I <br /> [I SPECIAL SPECIAL <br /> Employee IDN ` 7 <br /> Application Accepted ey <br /> Data_k_ �_r r.-.-_. <br /> Final Inspection BY________ _ Date-_-_____ PERMIT-Approved by <br /> Character of 5011 to Depth of 3 Ft: PR/Sump 5911 Character: <br /> COMMENTS <br /> F--PE--T SC Received hoc Amount ate Perm Invoice i Permit ID# <br /> Code INFO By ash Remitted rVl R <br /> I <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4201 <br /> 1014/07 <br />