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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CpyO�gy�N(�a�MENTALHEALTH DEPARTMENT 1868E.HAZ'LTON AVENUE-STOCKTON CA 95205-(209)48&3420 <br /> NON-REFUNDABLE PERMIT CALL2O9 953-7697 FOR INSPECTIONS L EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CrrvTDP •" �1I'l°ID �+4 <br /> �.p 07.0�/' ' <br /> CROSS STREET O VA% APN PARCEL SIZE 0._,.�((� e <br /> OWNER NAME eV-� �' "" L PN NE (Jn <br /> OWNER ADDRESS ���`2"� — ! yj CRYISTATEIZIP • l <br /> CONTRACTOR"T 01-75 PHora�04(^� <br /> DDNTMDrOR ADDRESS �lr� �I CITYMATEM t]e <br /> LICENSE UC42 QC-36 OTHERIl i` NUMBER y:�S S7 XPIRATION DATE <br /> WATER TABLE OEM: IT GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST N BUILDING PERMIT# O LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAINADDRION I ENGINEER DESIONEOIALTEANU E <br /> J REPLACEMENT fl OUT-OFSERVICESEPTICSYSTEM 441 DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE OMMERCIAL Ll OTHER NUMBER.F LNING UNITS: NUMBER OF BEDROOMI I NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFO P. L. CAPACITY L'200 gal N OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal ROFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL _ft FIX01 KW It PROPERTY LINE ft <br /> Cl LIFT STATION SIZE TYPE OF PUMP O FKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> f <br /> LEACH LINES Tl LEACHING CHAMBERS NOFLINES Z LENGTH OF LINES 0_ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WtoTR R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL tt FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED vamH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE It <br /> ❑ SUMPS WIDTH It LENGTH R DEPTH It <br /> DISTANCE To NEAREST WELL R FOUNDATION It PROPERTYLNE R <br /> ❑ DISPOSALPONDS WIDTH R LENGTH ft DEPTH It <br /> . / DISTANCE TO NEAREST WELL ft 115UNUATION ft PROPERTY UNE ft <br /> �Y( SEEPAGE PITS NUMBER –Z— WIDTH DEPTH ZS R <br /> DISTANCE TO NEAREST WELL,Q _II FOUNDATION ft PROPERTY LINE R <br /> 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 /> MINIMUM 24 H R AOVA NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 95.7-769 <br /> SIGNED TITLE_ 0i _ DATE <br /> fir+ s r L <br /> ` T <br /> Ali <br /> i <br /> J A <br /> c3EPARTMENTgSIVOULY <br /> Application Accep I Date Area Employee]D# 'S, <br /> Filial l napectio0 Date ❑ SP IALPERMIT-Approvedby <br /> Character of Soil to D th of 3 Ft: PI ump Soil Character: <br /> COMMENTS 1 Lco / 7 <br /> 49 – 7L - CL <br /> LC ,IL/ 79/ <br /> PE SC Recelvad eCFl- Almunt Date Parmfl/ Invoice# Permit ID# <br /> Code INFO B Rrnnined Service R umt# <br /> l L,-a *2545 fa�.A� 9/13 <br /> 42-001 – �La/Ni ONSITE WASTEWATER TRTMNT SYSTEM PFf <br /> Q4112 7 <br />