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16730) <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 810-do3oYp <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3W WEBER AVE-3"FL-STOCKTON CA 95202 -(209)4WM20 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 MR INSPECTIONS EXPIRES 1-YEAR FROM DATE IssueD <br /> Jog ADDRESS `l o <br /> CROSS SfREEr /�'`'-e oe /�L� APN I R 3-3,7�-6 PAQCEL SIU d A C 0 <br /> OWNERNAME [i JCi(J /. • 9 <br /> PH ONE <br /> `I OWNERADDRESS <br /> , Ap� __ CITY/STATVLIP <br /> L✓ <br /> CONTRACTOR , t o-7e— L- Pxoxe 3G 8'-99 3�a <br /> CONTRACTOR ADDRESS \�CA-** CIY/STATFIZIP <br /> LICEYBE -42 .']C-36 OTHER <br /> NUMBER J�VqIL Z EXPIRATION DATE_1CD --O <br /> WATERTABLEDEPTx: 'DO ft GCOGRAPHICALINFORMATION: Coordiaste X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION X <br /> TYPE OF WORK: NEw INSTALunoN ❑ REPIUVADDITION Cl ENOINEERDESICNED/ALTERNATIVE <br /> ❑ RYp"cES1EMi ❑ DESTRUrn <br /> INSTAL},A/TI ON WI LL SERVE: ESIDCNCE ❑ COMMERCIAL ❑ OTHER <br /> �,,/�IYCMRER Op LIVING UNITS: /( l N MR O B OO N OPE EES <br /> ll S PTIC TANK TYPE/MFG(--SGP CAPACrtrL &SINe P1 #OFCOMPARTMENTS <br /> C❑ GREASE TRAP TYPF/MFG CAPACITY pl KOFCOMPARTMEATS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL /L96> ft FOUNDATION It PROFTHTY LINE —,�O ft- <br /> ❑ LIFT STATION Sm TYPEOFP"p ❑ STM' IL SEPARATOR(ENCIDSED 5r5FGT <br /> ❑ LEACH LINES �j ACHING CHAMBERS �S LLK• S If OF LINES J_ LENGTH OF LINES <br /> (DISTANCE TO NEAREST WELL Z6DI00 O ft <br /> R FOUNDATION IO R PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTX R <br /> DISIANCETDNEARPST WELL-ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH It LENOTH R DEPTH ft <br /> DISANCETONEARmEr WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH If DEPTH ft <br /> DIETANCETONEAREST WELL ft FOMDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TONG WELL ft FOUNDATION R PROPERTYLINE ft <br /> �J SEEPAGE PITS W. ft LENGTx_ A ft DEPTH A I ft <br /> DISTANCETONEARIEST WELL / R FOUNDATION "o , A PROPERTY LINE —;L-5-' ft <br /> I HEREBY CERTIFY TP IAVE PREPARED THIS APPLICATION AND THE WORK WILL BE PONE IN ACCAMANC6 WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND RECO ONSDF SAN JOAQDHS�COUNTY. - <br /> DV EE'IPOTICE REQUIRED FORINSPE^CIl-ONS--PLEASE CALL(IN)913-76Q7 <br /> SIGNED nu.E //Wv DATE 1/-/3-03 <br /> 12 <br /> `tJ <br /> DEPARTMENTYSE/GNLY UC <br /> Appliadon Attepled BY D. //LN/�, Ara a� Employec v � <br /> Fieal l tlp f OR BY Date /_�/, 0- d?9 ❑ SPECIAL PERMIT-Appmved by_1� <br /> CM1aracter of Soll m Depth o 3 FU FIUSUmp Soil clmt.er: <br /> COMMENTS <br /> LEli -4- � <br /> PE SC RNNI h.W ADNDRI W4 Perml✓ IpYoiaP PerMTIDp <br /> ` Cade INFO <br /> By Cash RemiHsd Servlet uest If <br /> �sL SZ�7 EI 5 bE(o <br /> k-0I�1 <br /> 2 LD <br /> ONSITE WASTEWATER PERMIT <br />