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J^ ONSITE WASTEWATER TREATMENT SYSTEM PERMIT r <br /> B SANJOAQUINCOUNTYr 'RONMENTALHEALTNDEPARTMENT SF WEBER AVE-3-FL-STOCKTON CA 95202 -00"161420 <br /> y NON-REFUNDABL MIT CALL(209)953-7697 FOR INSPE S EXPIRES I YEAR FROM DATE ISSUED <br /> 2 CITY/2AP <br /> he <br /> JOB ADDRESS <br /> CROSS STREET APN I ,I 1 1 O_ Z¢ PARCEL$IlE ' <br /> CO± <br /> y - OWNER NAME E PHONE 7069 — <br /> OWNER ADDRESS Cm/STATE/ZIP—/CiOT .OfJryyy�'/S��/T�/T�J� <br /> CONTRACTOR '' 'PHONE <br /> y - CONTRACFORADDRESS Ayc,"J J}'A(Ert///JItiCS CITYISTATE21P <br /> LICENSE 0C4 Cl C-36 OTHER NUMBER ExPIMTION DATE J <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: COnrdlnatee X Y <br /> ` ❑ PERCTEST(S) NUMBER LAND USE APPLICATION N <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAUVADDRION ❑ ENGINEERDESIGNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> BOB NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBEROFEMPLOYLES: C <br /> ❑ SEPTIC TANK TYPE/MFG f/. de �r CAPACITY CJ gel ROFCOMPARTMENTS_ <br /> ❑ GREASETRAP TYPE/MFG (l CAPACITY gel X OF COMPARTMENTS <br /> (3 PKG 7X PLANT DISTANCETONEARESr: WELL A FOUNDATION a PROPERTY LINE R <br /> y <br /> ❑ LIFTSTATION SIPS TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOF LINES LENGTH OF LINES ySC/ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl at <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH fl <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> y DISTANCETONEARETT WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH ft <br /> DIBTANCETONEAREST WELL IF FOUNDATION fl PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> y DISTANCETONEAREST' WELL it FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH A DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE fl <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 /> /J M�I/NJMUM L HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)993-7697 L <br /> SIGNED TITLE DATE 025 <br /> y <br /> 1 <br /> 4N 1 <br /> I <br /> y I I <br /> 6 <br /> O <br /> 40 Lm 94, <br /> U LIC EP U <br /> EN Ru Do fif <br /> r <br /> DEPARTMENT USE ONLY II <br /> �Application Accepted V Date 1 Area 2'G Employee lm 01!m <br /> a Final lnFwa. By „j� Dale ",23 ❑ SPECIAL PERMIT-Approved by <br /> Charter of Soil to Depth oft Ft PIUSump Soil Character: <br /> r 1 j COMMENTS <br /> low PE SC Retsived CheckN/ Amount Data Permit/ tnit InvoiceN PerIDN <br /> Co2de INTO B Remitted Servit.Rantoul IF <br /> 0 115 GS a 33 <br /> A2-01-0 1 <br /> l2OA)2 ONSITE WASTEWATER PERMIT <br />