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i <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46&3120 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADUAESS 9/b WEST G/?EWE2TJE;D. CIT,2IP /,A OP 95330 <br /> CROSSSTREET 1-S fKINfAGE KD- APN /9/-Z60-22 <br /> PARCEL sQE 31.Q c <br /> OWNER NAME Het✓Est P#Wei N1 /. C . PHONE /93-/LsB 11 <br /> OWNER ADDRess 430 MA//J ffae67- CtMSTATEZPJAN LQC NC/9c0 CA cI'{/OS <br /> CONTRACTOR PA01105T PHONE 4'.2 SZ r I <br /> CONTRACTORADDRESS 13.7 5. 3RPd ✓E• / CITWSTATFJLP ORKDALE CA 9536/ <br /> LICENSE QC42 QC-36 OTHER RCE NuNBER 75477 ExPIAAnoN DATE 6//Z <br /> WATER ABLEDEPnf: ��Q fl GEOORAPRICALINFORNATION: Coordinates X Y <br /> P CTEST 0!2—j— I BUILDING PERMIT# LAND USE APPLICATION#_PA-/2001// <br /> �/TYOF WORK:WORK: ❑ NEWINslIALLATION ❑ KEPARVADDITION 0 EHOWEERDESIGNEOLALTERNATNE <br /> ❑ REPLACEMENT O OUT-OF-SERNCESEP7H:3Y2TmA 0 DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE C1COMMERCIAL O OTHER <br /> NUYBER OF LINING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEAMFG CAPACITY gal OWCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARpWENTS <br /> DBTANCETONEAREST: WELLB FOUNDATION It PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ IRKS TX PLANT ❑ SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES G LEACHING CHAMBERS #OFLINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL A FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED IMDTN ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION it PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION A PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH fl DEPTH it <br /> DISTANCETONEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM&24 H06&DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209)953.7697 <br /> SIGNED TITLE RL-E DATE 5-7-12 <br /> 141 <br /> e <br /> ZFE IN <br /> NT <br /> f0 <br /> SA <br /> --TTF-1- <br /> DEPARTMEN <br /> Application Accepted By to Ama Employee IDS <br /> Final Inspection By Date '7� ❑ SPECIAL PERMIT-Approved by <br /> Chamcter of Soil t0 Of t: PI Sump"I Charactar. <br /> COMMFJJTS <br /> PE SC Rea1YW ITec Amount Data <br /> Fail Imola# Permit lD# <br /> COMB INFO B Remkbd Service Re at# <br /> 222. 2_1 14, 36 00 <br /> ONSITE WASTEWATER TlaM SYSTEM PERMIT <br /> entna <br />