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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 /> NON-REFUNDABLE PERMIT CALL 209 95$-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 13Lr7-ZSf.�E5CftL0T3 'FEU-0-r4 'n C.,Zp ESCA-LOTJ Q5"37-0m <br /> ,t, ya <br /> CROSSSTREET `�!�� '• �S APN w�� ��_ 01PARCEL SO:E II ( �t�-• v <br /> • OWNERNAME (M/15--�tsylILLLE-M/9- 01JFffL-DRLEA-IE2>IX �(P�HONE F13�-�(dz- <br /> WN <br /> OERADDRESS ZLPC?rC F-'D <br /> ,. r�N1��I. AVE.fabr�F`Y}'f . CRYISTATE21P VC,,-,L❑,,j CA gs37-0 <br /> CONTRACTOR WE: O,f]1"-- w�c,vYl• "Nm� PHONE <br /> CONTRACTORADDR ( <br /> ESs f' T LA). opoc- ST. CITYisTATEZP L-0D(,zK 9S-y`Fa <br /> LICENSE QC42 QC-36 OTHER NUMBER E%PIMTION DATE <br /> WATER TABLE DEPTH: R GEOGRAPMICALINFORMATION: Coordinates X Y <br /> X PERCTEST #� BUILDING PERMIT# LAND USE APPLICATION# i <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADOITION ❑ ENGINEERUESIGNEDIALTEUNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NDMBEROFL=UNM: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACRY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DI6TANCETONEAREST'. WELL It FOUNDATION It PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP ❑ PKGTXPLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTERSED WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH R DEPTH It <br /> DISTANCETONEAREST WELL It FOUNDATION R PROPERTY LINE It <br /> ❑ sumps Worm It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH It OEM It <br /> • DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY UNE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILLBE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMU 2 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED nT C owSVl DATE <br /> �♦ ��,,.Lm 1 I — 9 17 <br /> III Ii�P' -`- - - - -q�T�I € - ` •4NT <br /> U <br /> I _ J <br /> X 4 r P O <br /> q UIN <br /> 7yI IIS a 9� - d( X Iilk dlRRII I THDzq OSZNAL <br /> MN <br /> gp � <br /> I --II <br /> EPARTMEN U QN <br /> Application Aeeepced By Dace (� � Area Employee ID# <br /> Final Inspection BY Date ❑ SPE IAL RMIT-Approved by <br /> CharecterOf Soil rn DeOth of 3 Ft PiUSUMP Soil Character. <br /> COMMENTS SPG-?CSARLMfT�'K� 8� PAR-c-L 3+I} • 44D/ rRoM <r-AWFJp Cn/aw <br /> ,44Ai4bo 4E.bQ PlSIQC,C A2 370 FAOm . PAOPEAT uv_ AAIJ So- of S. ��6PEA r <br /> • i„-I'�:- PARC-rd- I : .2 70'fzoM C fA4?6A7Y L,,Jr- q,r 'A4 aF 5. PRaPE.a.r 1-W&. <br /> PE SC Receivetl Chee Amoun[ Parmid Invoice# PermitlDft <br /> Code INF. B ash mittn Dace Servic R uest# <br /> 4LOt ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />