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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQVIN COUNTY ENVIRONMENTAL HEALTH DEPARI MENT 304E WEBER AVE-3-FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953.7697 FOR INSPE('TIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6//�V D $ a N @ CITY/ZIP <br /> m <br /> > <br /> • CROSSSTREET L49 APN % <br /> 0--29 PARG'EI,SI'LE <br /> 1I n <br /> OWNER NAME T O P 5 1 C.!/ PHONE f2 <br /> OWNER ADDRPSBCITV/STATWZIP_ <br /> CONTR /�ACTOR D V` O H \O y g Y KC / O M PHONE 93/- / 6 <br /> CONTRACTOR ADDRESSZCI1'Vl$TATFIZIP <br /> LICENSE ❑C-42 LI C-36 OTHER NUMBER •�(J{7 4 EXPIRATIONDATF 6 30-O �j <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdiRate3 X <br /> ❑ PERCTEST(S) NUMBER LAND USE APPLICATION#__ 1 n <br /> v I 1 <br /> TVPEOF WORK: New lNsrwLUTIQN ❑ REPAIP/ADDITION ❑ ENGINEER DESIGNED ALTERNATIVE I <br /> ❑ REPLACEMENT ❑ DESTRUCTION 1 _ <br /> INSTALLATION WILLSERVE: RESIDENCE ❑ COM.MERCIAL4 ❑ OTHER__ lvA' <br /> NUMSER OF LIVING UNITE: .__ NUMBER OF BEDROOMS: —r NUMBF.ROFEMPLOYF.k3: <br /> ❑ SEPTIC TANK TYPE./MFO � �ZT-tY'01F G CAPACITY /(000 -, gel #OFCOMPAMMENTS__, <br /> GREASE TRAP TYPE/MFG CAPACHY _ d� gel #OFCOMPARTMCNTS <br /> 13PKG TX PLANT DISTANCETUNEAREFT: WELL /00 'P ft FOUNDATION 7 - tl PROPERTY LINE_ -4PROPERTY Rv <br /> ❑ LIFT STATION ��AASim TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED I...I <br /> pI <br /> ❑ LEACH LINES LEACHINGCHAM8ERS " • +'Vt a'r.Y 4O LINES "� LENGTH OF LINES—A-0— R <br /> Du;PANCETO NEAREST WEU. /OO R FOUNDATION /0 ft PRWERTY LINE H <br /> ❑ FILTER BED WIDTH R LENGTH It DEPTH R <br /> DISTAN(ETONCAREST WELL B FOUNDATION__,_,__R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R I£NOM_ I DEPTH_ It <br /> DISTANCE TQNEAREv WELL R FOUNDATION it PROPERTY LINE R <br /> ❑ SUMPS WIDTH A LENGTH D DEPTH H <br /> DISTANCE TO NEAREST WELL H FOUNDATION --_„-_fl PROPERTY LINE___,_,__ It <br /> ❑ DISPOSAL PONDS Wttrtx ft LENGTH ._____ ft DEPTH_ <br /> DISTANCETO��N(EAREEA WELL R FOUNDATION_ ft PROPERTY LINE aa++��_f R j <br /> ❑ SEEPAGE PITS WIDTH TZ R LENGTH <br /> ' �'ft DEPTH _�J It <br /> • DISTANCETONEAREST' WELL 4P R FOIINOATION 3 O 11 PROPERTY LINE d <br /> 1 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 REGO LATIONS OF SAN JOAQU IN COUNTY. <br /> MIN IMUUyM224 HOV21)V N/C}-yQ�j1pE REQUIRED FOR INSPECTIONS PLEA.SEC .L M)q13-7697 ry <br /> SIGNED ALRKuf'L.N' lJ Ll JMTTJ✓� TITLE �O Et P`4 e7ON DATE' ��—J- <br /> r <br /> IF <br /> i <br /> t � <br /> I S ELM St <br /> I <br /> DEPA to MEN U O V /�/�/ <br /> Aypllcation Areeptetl By to I� U _ Aren Emyloyee 10# 0012�_T <br /> Firm Inspection By Dete ❑ SPECIAL PERMIT-APpmved by <br /> Character of Soil to Depth M3 FL PrW-fSUmp sen Cha ter: <br /> COMMENTS �IO.W_�, <br /> • PE 8C Receiw.n Amount PermiU <br /> Code INw 8 T' Cnsh Remitletl Dale Servin Re uest4 lnvoia# Permit IDS <br /> 1 IBS 0 I'LISID3 Yl<00 35- 07 lof <br /> 1 <br /> az-DI-oDI <br /> i2RN2 ONSITE WASTEWATER PERMIT <br /> 'F <br /> I <br />