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ONSITE't.-ASTEWATER TREATMENT SYSTEM V_AMIT <br /> SAN 3OAQUIN COUNTY ENVIRONMENTAL,HEALTH DEPARTMENT _ ' 600 E MAIN SIREE7-STOCKTON CA 85202-(209)468-3420 - <br /> NORAEFUNDABLE PERMIT t/ CALL(209)9$3-7697 FOR INSPECTIQN$ EXPIRES 11 YEAR FROM DATE ISSUED <br /> J08 ADDRESS InJr Y •± .teA cnyrzp !F ► .7sf17 'ex <br /> CROSS STREET A_ f.1 APNof— PARCEL she 'i?0 - 9 a <br /> OWNER NANH- �i';E "4,k L4rA PHONE IJ <br /> r OWNER ADDRESS. 13.4 CRYISTATIL <br /> CONTRACTOR PHONE 7:Z 1Xz9.k_#—�1_£i b4&f& <br /> CONTRACORAOORESC17YSTATwvP44:,AXal,.(A <br /> F- <br /> Q <br /> 1 .LICENSE ❑C42 ❑C46 'OTHER - NUMBER ExpulATiON DATE �. <br /> j <br /> WATER TASLE DEPTH.- - - - ft :GEOGRAPHICAL INFORNATION: Coordinates X Y <br /> PERC TEST N I BUILDING PERMIT LAND USE APPLlCATTON# - ^ <br /> -7 TYPE OF WORK ❑ 'NEW INSTALLATION ❑ REPAHdADDITION ❑ -,ENGBIEER DESIGNED IALTERNATTV6 <br /> ❑ REPLACEMENT - - 13 .DESTRUCITON <br /> IN WILL SERVE: ❑ RESIDEND$ <br /> NUMBER OF LNeIG UNRS: NUMBER OF BEDROOMS: NUNBEROF EMPLAYEEB: I <br /> - O SEPTICTANK. TYPEIMFG CAPACrTY- . <br /> ow #OF COMPARTMENTS <br /> 11.--GREASE TRAP TYPFIMFG ." - CAPACITY-. Qal $OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft- FOUNDATION ft ' PROPERTYLINE- - 'ft <br /> ' 0 LIFT STATION _ SIZE TYPE OF PUM 0. `PKO TX PLANT 0 SAND OILSEPARAT'Oft(ENCLOSED SYSTEet) ' <br /> O LEACHLINES ❑ LEACHING CHAMBERS 90FLINEs LENGTH OFLmEs R ' <br /> DISTANCE TO NEAREST WELL 1t'.. FOUNDATION ft PROPERTY UNE- ft <br /> L7 FILTER BED WOM fl. LENGTH <br /> It DEPTH <br /> R <br /> DIWANCETo NEAREST` WELL ft FOUNDATION .4 ft PROPERTYLINE ft. ♦: <br /> t 13 MQUNDED Waym ft LENGTH d-.' ft Det ft <br /> .. DISTANCE TO NEAREST WELL ft FOUNDATION:, $ PROPERTY LINE ft <br /> D SUMPS WmTR fl. LENGTH R DEPTIiR <br /> 'V .DISTANCE TD'NEARFST WELL - ft FOLkNDAT10N E .i ft PROPEkrYLINEL - <br /> a _. �- - r...: <br /> R <br /> D DISPOSAL PONTIS Wmrli . ft LENGTH r- ' ft DEPT1i g + <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> p SEEPAGE Pf75 Nuleeele WID7Tf fl DEPTH <br /> t.a <br /> _. .-.. .. DLR"TANCE TO NEAREST-`:_ WELL - - ft FOUNDATION - R J PROPERTYLINE <br /> t w 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATIONAND THE WORK WILL BE DONE IN ACCORDAHGE WITH SAN JOAQUIN COUNTY ORDINANCES, f- <br /> ff STATE LAWS AND RULES AND REGULATIONS OF3AN JOAGUIN.COUNTY.- <br /> MI UNI FfQiJR,AEAIANGE NOTICE I2EQLIIREO FCR INSPECT1p,Nf$�PlE1LSE CALL{2p9)853-7687 ,�T <br /> SIGNED " moi T►TLE �{LI 4�Y x l jet�_ DATE +r <br /> { <br /> ! ' <br /> rove <br /> VA k <br /> � 14.oa L 1, <br /> It <br /> t �»' ICC .. %,' <br /> F <br /> �. F DEP.ARTiILEr�iTUs •ONL _ E <br /> ' AppllcaflOrl Accepted By F ATea Employee ID# 5 <br /> Flrutl h lspdetiaTl By, Date ❑ SPECIAL PEftAAl1T Approved by <br /> Cheraafnr of Soil to Depth of 3 Ft PItlSump SoilCharacteT: <br /> ;. <br /> COMMENTS'- { <br /> PE SC 1"Ived - Amount Qate PermFt! FeeS <br /> Code iwr6 if. Remitted Service uest i lmrOPermit 10# <br /> IV <br /> - 31 �1vS•� INCA) , <br /> 42-01 - - ONSITE WASTEWATER TATMNT SYSTEM PERMIT <br />