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ONSITE WASTEWATFT> TREATMENT SYSTEM PERMIT <br /> 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ��// 304E WEBER AVE-3Y°FL-STOCKTON CA 9.f, (209)MAL3420 <br /> `NON-REFUNDAB(L)E PERMIT -T CALL(209f953-7697 FOR INSPECTIONS EXPIRES <br /> (IP YEAR FR*DATE ISSUED <br /> JOB ADDRESS <br /> -I I4 E_ 7'P<t1o.�3T Hl. ^ CITYI/'I.IP PeA-iNkr 0 /��-J <br /> CROSS STREET �.Ww�, APN 00'7 3 -PL O� 5FT>-Zy� ° <br /> PARCEL SITE ° <br /> OWNER NAME I��-A�1�� A� �Ya- PHONE <br /> OWNER ADDRESS Le7�V1�AAl A7n) �TTt)oU6 COVISTATFIZIP <br /> L CONTRACTOR JPN 1`-\ J `VF, 11-11 ZL 1C1 //--PHH.O�NE ✓1```9`-7-5,A5/- <br /> CONTRACTORADDRESS ISS I Iv, �RnFfD�PtY 1�c, CFI'Y/SSTf <br /> TTAATEIZIP OIV UIy tC Kq"�L JP�[J✓J <br /> LICENSE tIC42 Ll C-36 OTHER NUMBER �J `e) E%PIRATIONDATE <br /> WATER TABLE DEPTH: ft CEOCMPHICAL INFORMATION: Coordlnatef .� Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATON# <br /> TYPEOFWORK: ❑ NEWINSTALLATION lb--REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> p ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: IIrT RESIDexce ❑ COMMERCIAL ❑ OTxea <br /> NUMBER OF LIVING UNITB: I NUMBER OP BEDROOMS: � NUMBEROF EMPLDYEEIi: I <br /> FY SEPTICTANK TYPF/MFG 1�1� LyIVLiM'CA OCAPACIN gel #OF COMPARTMENTS <br /> LCl GREASETRAP TYPFIMFG CAPACITY 931 IINCOMPARTMENTS <br /> ❑ PKG TX PLANT DMANCETONGREST: WELL ft FOUNDATION N PROPERTY LINE ft <br /> ❑ LIFTSTATION SIM_ TYPEOFPUMP. ❑ SAND OIL SEPARATOR(ENCLOSEDSVORM) <br /> I ,,L <br /> UT I.EACH,EINES ❑ LEACHING CHAMBERS IS LINES !r LENGTH OF LINES �v fl <br /> Y` S' R <br /> DISTANCETONEARHS,r WELL 1�n FOUNDATION R PROPERTY LME <br /> ❑ FILTER BED WIDTH H LENGTH it DEPTH ft <br /> DISTANCRTONEAREST WELL R FOUNDATION ft PROPERTY LME it <br /> ❑ MOUNDED WIDTH it LENGTH fl DEPTH ft <br /> DISTANCRTONEA,tMr WELL R FOUNDATION fl PROPERTY LINE R <br /> ❑ SUMPS WIDTH A LENGTH R DEPTH R <br /> DISTANCETONEARE.4r WELL ft FOUNDATION fl PROPERTY LINE ft <br /> CLj� ❑ DISPOSAL PONDS WIDTH fl LENGTH fl DEPTH ft <br /> DISTANCEW�2NNE��A�R�EST WELL-ftFOUNDATION It PROPERTY LINE ft <br /> (a' SEEPAGE PITS WIDTH �xAFST C1I' J <br /> fl S!e®- 't'T-' 4 �/ -11L DEPTH Z L�fl <br /> DISTANCETONEARWELL I �'Y-ft FOUNDATION I S ft PROPERTY LME .J R <br /> L 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 /> MINIMUM34HOUR ADVANCE NOTICE REQUIRED FOR INSPEECTION,SS-PLEASE CALL(209)953-9697 <br /> SIGNED TITLE DATE 111041,03 <br /> J <br /> L <br /> L - <br /> - - <br /> l <br /> N N <br /> E <br /> �I DEPARTMENT U;W O V <br /> Application A PIDate �� j 3 Are / Z Employee ID#__5� <br /> Final Inspscti EyDate e if' d ❑ SPECIAL�PERMIT-App., by / 7% <br /> Cbarader of Soil to Dep, of 3 Ft: PIUSump Soil Chaoeter. <br /> COMMENTSt//0)1'— ADL-2�0!I ( 7 <br /> LPE SC ttelve bed#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> L42,01-NI ONSITE WASTEWATER PERMIT, <br />