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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> L SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 309E WEBER AYE-3"FL-STOCKTON CA 95202-(209)469-3420 <br /> NON-REFUNDABLE PERMIT CALL(200r9))953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1/357/ E iDIHwY im CITY/zip <br /> r 2 I� n <br /> CROSS STREET SObX`G. APN ©O, 1 <-Q 13 PARCELSIZE to aUeg <br /> OWNER NAME �i-:Av yp J'FF/ PHONE ZC.S'- 57Z,�. <br /> OWNER ADDRESS CITY/STATEJZIP <br /> CONTRACTOR t/ � /�/ra./�co�G PHONE �G6J'tiZJZ7 <br /> CONTRACTOR ADDRESS /1/)/A7 E CN/C4 //ILGC CITY/STATEJZIP <br /> LICENSE PIC42 UC-36 OTHER NUMBER E%PIMTION DATY <br /> WATER TABLE DEPTH: R GEOGRAPHICALINPORMATION: COo-diNhf X Y C` <br /> Cl PERC TEST(S) NUMBER LAND USE APPLICATION II IV <br /> TYPEOFWORK: 1❑-� NEW INSTALLATION 13REPAIR/ADDITION 13 ENGINEER DESIGNED/ALTERNATIVE <br /> R REPLACEMENT ❑ DESTRUCTION I� <br /> INSTALLATION WILLSERVE: KRFSIDENCE ❑ COMMERCIAL ❑ OTHER '1 <br /> Bra NUMBER OFLIVMG UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> a SEPTICTANK TYPFJMFG ��` CAPACITY 1401) gai NOFCOMPARTMENTS__.�, •JLC+ <br /> ❑ GREASE TRAP TYPEJMFG CAPACITY gal N OFCOMPARTMENTS <br /> l <br /> I•R ❑ PEG TX PLANT DISTANCETo NEAREST: WELL 5-0, ft FOUNDATION 7• H PROPERTY LINE /L{7 f ft <br /> ❑ LIFT STATION Sm TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS R OF LINESLENGTH OF LNES <br /> 4 DISTANCETONEAREST WELL /C ft FOUNDATION ,]Q r It PROPERTYLINE .SIJ I fl <br /> ❑ FILTER RED WIDTH ft LENGTH ft DEPTH ft <br /> DISIANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED W.. ft LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS W. ft LENGTH ft DEPTH ft <br /> DIWANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE fl <br /> uL SEEPAGE PITS WIDTH X11 ft LENOTH fl DEPTH D�S� fl <br /> DISTANCE TO NEARF3T WELL //(J R FOUNDATION 1?0 R PROPERTYLINE I r fl <br /> 6. 1 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 /> MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(269)953-7697 <br /> SIGNED TITLE �is� DATE Ld� <br /> L <br /> o = <br /> L <br /> iY <br /> r <br /> I <br /> ` UI G <br /> BL H nL BD <br /> DEPARTMENT USE ONLY <br /> Application Accepted Date11C,11��/y Am 3 Arca y�I.,y� Employee IDM <br /> FlnM insImm lon y Dah ❑ SPECIAL PERMIT-Ap mvcd by <br /> Character o(S Mpth TIFL�,t/I Pius.-P Soil CBa/racier: <br /> ti OMMENTS A II n a,Vd� f.L7 I d-,. A * _ <br /> i <br /> L PE SC RceAved Ch Amoon[ DRh Permitl nvoke M t IDM <br /> Code INFO B ash Remitted Serviee Re Perm uestM <br /> yl lbI i h V-Vol6D D XJ Z2 . <br /> L <br /> 42-0(Jpl ONSITE WASTEWATER PERMIT <br /> 4241- <br />