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U .V(/)irt <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AYE-3"FL-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> —rte ` N <br /> JOBADDRESS � lI(2'QI f f)�ir -2(2 CITYfIZIP 1�J YQ1QI1 <br /> CROSS STREET 1\ II APN ZL-1— IN\>` I� I�•V� ' <br /> PARCEL SIZE /l p <br /> L OWNER NAME Bprtod_Tlu�p BP-020 Loi PHONE �1© { "1 <br /> OWNERADDRESS J HY)I Qr CITY/STATE/ZIP <br /> LCONTRACTOR �7n Pf PHONE <br /> CONTRACTORADDRESS CITY/STATEIZIP N <br /> O <br /> LICENSE ❑C32 ❑C-36 OTHE0. NUMBER EXPIRATION DATE <br /> L WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC MST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ RrmiVADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMEN ❑ DESTRUCTION 6r <br /> LINSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ��w ` .�NUM''BEE^R��OF BEDROOMS' I rye NUMBER OF EMPLOYEES: �- <br /> SEPTIC TANK TYPE/MFG YVWL':FM IJMUk—CAPACT' IMM EBI #OFCOMPARTMENTS A <br /> S <br /> Y ❑ GREASETRAP TYPEIMFG CAPACITY Sal #OF COMPARTMENTS <br /> L ❑ PKG TX PLANT DISTANCETONEARFST: WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATION Sim TYPE OF PUMP ❑ rS�AND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHINGCHAMBERS 0 O LINES °S LENGTH OF LINES '60 � ft <br /> DIWANCETONEARII WELL� R FOUNDATION >10 R PROPERTY LINE X00 R S <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R p <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCETONEARFST' WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONFARFST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> L DISTAncETONFIARE WELL ft FOUNDATION ft PROPERTY LINE R <br /> SEEPAGE PITS WIDTH 4.11 ft LENGTH ft DEPTx 2.�) It <br /> L DISTANCETONEAREST WELL -Leo It FOUNDATION 7 (O ft PROPERTY LINE SBV ft <br /> 1 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 /> �INIMUM H HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)951-7697 l <br /> SIGNED _'r _ / TITLE DATE �-21'-03 <br /> L r <br /> L <br /> I <br /> 1 <br /> L SA J A IN GO N . <br /> ❑I qrl <br /> DEPARTMENT USE ONLY-T -� <br /> Application Accepted By Data An.X21 Q3 AreaI Fmployrs Idi �T <br /> L Final lmpation 8 w4leData/� � ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth FU HIStan $oil Character: <br /> COMMENTS <br /> LPE SC Received ec Actions Date cermfU Invoice# Permit Im <br /> Code ISMB J Remitted Service Re Inst# <br /> 42n 117 k 3�a 4S 33 6 <br /> L42.01-00I <br /> 121L02 ONSITE WASTEWATER PERMIT <br />