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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CWNTY ENVIRONMENTAL HEALTH DEPARTMENT 300 E MAIN STREET-STOCKTON CA SS202-(209)OES-3620 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ?�2 3 S. /Zcy Crap <br /> CROSS STREET iFW Y / L APN Z J S 0 90 Y PARCEL SDE SMAC 7S <br /> OWNER NAME �� . $ c 1✓. V�FTL PHONE 9/,/ <br /> OWNERAnomse; SAME CRYISTATEW <br /> CONTRACTdi 21,f 7-2- L4A)�J6 is A/'�CO 1)5r 2 9/0 <br /> Cow"ICTOR ADDRe9s crosTA,,mP /KdCCA 9�J GV <br /> LICEIME QC42 QCJ3 OTHER A ' AIA T NUMBER C i'oozy <br /> pLOp 1 EximMATION DATE %//i:1,�I <br /> 1 <br /> WATERTABLE DEPTH: t1G GEOOMPNICAL IHFIXiW1TpN: COONIrIY1M % Y <br /> PERC TEST i BUILDING PERMIT# LAND USE APPLICATIONF7 <br /> TYPE OF WORK: 11 NEW INBTALLATION ❑ RFPAWADMTM)N ❑ ENGINEEN OEBKTtIEp IALTERNATVE <br /> n REPLACEMENT 0 C)UT-0FSERVICESERICSYSTEM ❑ DESmucTION <br /> INSTALLATION WILLSERVE: 11RESMENCE 11M <br /> CommeacL ❑ OTHER <br /> NUYBEROPLWMOUMIS: NUMBEROf BEpa00Me: NUMBER OF EMPLOYEES: <br /> ❑ SEPTCTANK TYPE/MFG CAPACITY Bal OWCOMPANWENIS <br /> ❑ GREASE TRAP TYPPJNIFG CAPACITY gal #OFCOMPAITMENTS <br /> DISTANCEm NEAREMT: WELL A FOUNDATION R PROPERIYLINE R <br /> ❑ LIFTSTATION SIZE TyPEGFPUMP O PKGTXPLANT O SANDOILSEPARATOR(ENCLOSEOSYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS #DF LaR:S LENGTH OF LINES <br /> DISTANCE TO NEAMEBT V fl FOUNDATIONit PROPERTY LITE ft �L <br /> ❑ FILTER SED Wamt fl LENGTH ft DEPTH it A' <br /> OBTANCEMNEARmT WELL ft FOUNDATION fl PROPERTY LINE fl <br /> ❑ MOUNDED Warm ft LENGTH it DEPTH it <br /> DISTANCETONENREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST KELT ft FWNDATON R PROPER UNE fl T' <br /> ❑ DISPOSAL PONDS WMTH ft LENG1H it DEPTH R b' <br /> DISTANCE TO NEAREST w ft FOIINOATIW it PROPERTY LINE it I.l <br /> ❑ SEEPAGEPITS Nueaan INE H it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION-ft PROPERTY❑NE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE YIORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 UM 24 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9 -7697 <br /> SIGNED TITLE DATE <br /> Ir IAF E <br /> DEPARTM N U S <br /> Application Accepted By Data /D /4 1`0 Area EmpNWae ID# `J L <br /> Flml Impaction By Data ❑ SPECIALPERMIT-Approvedby <br /> Character of Soil to Depth of S F! Pk/Sump Soil Character: <br /> COMMENTS <br /> PE Code IMM SC R Biv�y RemkMtl DataSeMr»m upt0 ImroluB Permk lD/ <br /> /11 -eU <br /> 4241 - ^6 ONSITEWASTEWATERTRTMNTSYSTEM PERMIT <br /> Willa <br />