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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAV JOAOUIN COUNTY ENYIRONMENTM HEALTH DEPARTMENT 800 E MAN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOa ADDRESS 41SZO WP--JO N,1- CM0p SIDL4T ��S m <br /> i <br /> f�� w <br /> • CR093 STREET FTcTRC.E}TA T1 APN 101 - 120 -Zg PAaar.SDE A0.y� e <br /> OMERNAME ���-Z��� �P-GJC PHONE <br /> DINNER ADDRIll�(�p CT'/STATEIZW <br /> TRACTOR N <br /> CON _:Stj r COT-i C� PHONE IIJ�P-�J(GT'!'ZS SZ. <br /> CONrnADroMLR',ADDRE99 �1 5 � <br /> . �e.ui L,-0 A.Pc, I O3 CITY/STATEZLP DZr rRS <br /> CA ZC(o <br /> LICENSE VC. QC-36 OTHER NUMBER X548 EXtNRATIONDAra OZ.01I I <br /> WATERTASLEDEPTH: R GEOGRAPHICAL INFORMATION: C00rDInet9a X Y <br /> . ❑ PERC TEST # —� BUILDIN13 PERMIT# LAND USE APPLICATION# <br /> TYPE DF WORK: V NEWINSTMa, N ❑ REPAINADODIOtI ❑ ENGINECROESIONEOIALTERN6TNE <br /> ❑ REPLACEMENT ❑ 0ESTRUCT4N <br /> INSTALLATION WILL SERVE: ❑ RESAENCE 1f COMIIERCLAL ❑ OTHER <br /> NUNBEROFLMNG UNITS: � NUMBE OFBEDROOMS: NUYBEROFEMPLOYEES: <br /> Id SEPTIC TANK TYPE/MFG ?eL.,,1f.Pr /-XJI + CAPACITY�ZAO gal ROFCOMPAATMENTS �L <br /> O GREASE TRAP TYPERAFG CAPACITY gal #OFCOMPARTMENTS ISA 1 <br /> DNTANCETONEAREST: WELL YCJOt} R FOUNDATION S T R PROPERTY LINE R <br /> O LIFT STATION SIZE TYPEOFPUMP 0 PKGTXPLANT O SANDOILSEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES 15. LEACHING CHAMBERS #OFLNES 2 LENGTHOFLNES It <br /> DISTANCETo NEAREST WELL 1L 0T ft FOUNDATION toA ft PROPERTY LINE 7O ft <br /> 13 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOLNDATICN ft PROPERTY UNE ft <br /> 0 MOUNDED WIarN ft LENGTH R DEPM ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE R <br /> O SUMPS WImH R LENGTH R DEPTH ft <br /> OISTANCETONEAREST wl] R FOUNDATION ft PROPERTYUNE ft <br /> O DISPOSALPONOS WIDTH It LENGTH R DEPTH ft <br /> OISTMMTONE T WELL ft FOUNDATION R PROPERTYUNE ft <br /> OF SEEPAGE PITS NNBEA L'I INWH '5 T ft DEPTH ZS ' ft <br /> • OUITANCETONEAREST WELL ISO A+ ft FOUNDATION 10, ft PROPERTYLINE 1ST fl <br /> t HEREBY CERTIFY THAT I HAVE PREPARED TRIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SMI JOAQUN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIWMUj 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209)953-7897 <br /> SIGNED TITLEC. 'h'��L DATE <br /> 7. <br /> DTZ /O <br /> C.. <br /> •- i <br /> Q <br /> I <br /> J A <br /> 1 EP <br /> DEPARTME U <br /> Appllonlon Accept Daps 0 Area Employee ID# <br /> Flnal rlapactlOn B Data /O Q ❑ SPECIAL PERMIT-Appal by <br /> Cha ez,of Soil to d 3 Ft: P ar <br /> ump Soli ChacUm. <br /> COMMENTS <br /> • PESC ROcON"Ir ChIckill Amount ParmH/ <br /> Co#e INFO B Cash RamltteD Date Sanlce nest# Imdca# Permll lD# <br /> k1-3 0 <br /> 4201 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />