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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PEBIAIT <br /> IS CALL(20p�3-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ' JOB ADDRESS.L7ly6 FW reZZ/ /�PaQ �7p—CITY/hp <br /> CROSSSTREETY � /W�j�� �'rC-___ APN_Q t D.L OOfO PARCEL SIZE l •�O a <br /> ' OWNER NAME <br /> T.L. 7 SY1VK1 �r.+�a+S PHONE g2ey- -3s/,S- <br /> OWNER ADDRESS _ CITY/STATEZP <br /> CONTRACTOR 4 /N _.� l 4 e. PHONE 14.9-S-&2 7/ <br /> CONTRACTOR ADDRESSi7G I>>/<-JX __.CITYISTATF/ZIP <br /> LICENSE SIIC42 [JC-36 OTHER_ NUMBER 'YS50Ys EXPIRATIONDATE <br /> WATER TABLE DEPTH:_ it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> CI PERC TEST # BUILDING PERMIT#-J-q&j 9814-J-q& LAND USE APPLICATION# <br /> w TYPE OF WORK: JA, NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 0,RESIDENCES(� � t COMMERCIAL 11OTHER <br /> NUMBER OF LIVING UNITS:� NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG /JL., CAPACITYI gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL O a' it FOUNDATION S ft PROPERTY LINE ZLCD •" it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP_— ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �. LEACH LINES LEACHING CHAMBERS #OFLINES LENGTH OF LINES VO it <br /> DISTANCE TO NEAREST WELL ,IS-12 it FOUNDATION dro it PROPERTY LINE Ckti it <br /> ❑ FILTER BED WIDTH _ ft LENGTH it DEPTH II <br /> DISTANCE TO NEAREST WELLit FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE It <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELLit FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH_ - it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> SEEPAGE PITS NUMBER WIDTH ft DEPTH y N <br /> -� DISTANCE TO NEAREST WELL 5D i ft FOUNDATION S-0ItPROPERTY LINE /JM d- it <br /> I HEREBY CERTIFY THAT 1 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 /> MINIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED �• TITLE DATE / ! <br /> 1 <br /> d 14-P <br /> . o <br /> 1 ' <br /> a � <br /> � H _ <br />