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ONSITE WASTEWATER TRVATMENT SYSTEM PERMIT <br /> N AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"'FL-STOCKTON CA 95202 -(20c .14-3420 <br /> D6*REFUNDABLE PERMIT CALL(209)953-7W*AP40R INSPECTIONS EXPIRES I YEAR FROM DA"t UED <br /> BADDRESS f 50 CITYIZIP Ni 2Q Z-Z LA <br /> Ze <br /> M <br /> / m <br /> C STREET 40w �. <br /> S &t— a:r,,rv— <br /> e _ _ APN 00 26 A3q PARCELSIZE <br /> A <br /> Vfww NAME O C-Fg� PHONE �y <br /> VNERADDRESS S/�I7t>A _ CITYISTATPJZIP Pt CA SOD of- 7s�-.:Lz <br /> R ACTOR O PHONE S <br /> I lrrna AnnaFS9 CITYISTATWZIP - <br /> �PNSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> t. t TABLE DFPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L.ERC TEST # BUILDING PERMIT# S f LAND USE APPLICATION# <br /> 'PE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> C) REPLACEMENT ❑ DESTRUCTION <br /> LLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER 57Z?44C E <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: gf-2 -- NUMBEROFEMPLOYEES:O <br /> SEPTICTANK TYPE/MFG Y¢¢4 _.__ CAPACITY 12-dca gal #OFCOMPARTMENTS <br /> 1REASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMHNTS <br /> KG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 60 <br /> LIFT STATION SIzE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ' .EACH LINES ❑ LEACHING CHAMBERS Cyt #OF LINES <br /> �_�_ LENGTH OF LINES �)-[�,� R <br /> DISTANCETONEAREST WELL I�t ft FOUNDATION 4(./ ft PROPERTY LINE /.STT•/ ft <br /> FILTER BED WIDTH ft LENGTH ft DEPTH ft 1 <br /> DISTANCET'O NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> IOUNDED WIDTH ft LENGTH ft DEPTH ft C <br /> LA DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft rh <br /> SUMPS WIDTH ft LENGTH ft DEPTH ft ��1 <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> tISPOSAL PONDS WIDTH fl LFNOTx it DEPTH it <br /> 14 <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> �EEPAGE PITS NUMBER _WIDTH .r ft DEPTH 2.F r ft <br /> DISTANCE TO NEAREST WELL /SCR ft FOUNDATION Jam' ft PROPERTY LINE /5" r _ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INFM,AIU OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> C"'M // <br /> / TITLE I)Wgr-#;f DATE <br /> ..�. _�.- .... .M <br /> . 4gs.Da' N• bid ��'yq"w. <br /> 6.1 <br /> x <br /> s <br /> -16 <br /> N <br /> V <br /> �ACEN � <br /> - <br /> 7tt`m <br /> tr 2 c Z ON AQUM <br /> i... 4 ` a SANVSRO�NEMKNT <br /> ,-�y7HOE4.Pt� <br /> IV DEPARTMENT US ON V .I_ <br /> Date Area s2 Employee iD# �� T <br /> pplication Accepted 4� <br /> incl Inspection By <br /> Date ❑ SPECIAL PERMIT-Approved by <br /> atter of Soil to D th of 3 Ft; PitlSump Soil Character: <br /> L..4MENTS r �r <br /> ' SC Received Check#/ Amount Date Permit/ _ <br /> Lwde INFO B Remitted Service Re uest <br /> �i.rr I17 b`l 3'I-a.� ;f IL t) 37CJ`> � <br /> ON E WASTEWATER PERMIT - <br /> �003 <br />