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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT tOylS'r)- <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3MO FI.-STOCKTON CA 952P 209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(2 .I-7697 FOR INSPECTIONS EXPIRES <br /> t/I�YEAR FR ;TE ISSUED <br /> JOB ADDRESS j CATV//ZIIP / t y <br /> CROSS STREET uJ�UWC�\ C APN a�a�(/1(0 PARCEL SIZE(, <br /> OWNER NAME (� 1f1 71{In 1.\� ( n,���•�i � 1 firo i be. PHONE. <br /> OWNER ADDRESS CX/rao, �(��,,,,� X CITY/STATE./ZIP <br /> CONTRACTOR ft-el\ 0. �(\( {J.\i n (rr �S��e //PHONE <br /> � C G6 7 37D <br /> CONTRACTOR ADDRESS C&4, f-7(f� y Ib! anti CITY/STATE%ZIP- <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE.DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X V <br /> PERC TEST(S) NUMBER ( LAND USE APPLICATION# .1 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE V' <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER N <br /> NIIMBF.It OF LIVINt:UNITS: NUMBER OF REDROOMS: NUMBER OF EMPLOVEF.S: <br /> LI SE:PT'ICTANK IYet IMI(i CAPA(HY Rat 1100 C0MVAk1MLNIS_—__-_- <br /> U GREISETRAP IYPI./MI11 CAPAVIIN' gRl /101 COMPAR I MIN IS <br /> U PKG•I:C PLANT DISTANCE."I'(1 NF.AREXT: WI I1 11 FGIiNDA HON 11 PROPIRTY LINE 11 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LLNGI II OF LINES 11 <br /> DISTANCE TO NEAREST WELL fl FOUNDATION Il PROPERTY LINE 11 <br /> ❑ FILTER BED WIDTH B LENGTH Il DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH 11 DEPTH tt <br /> DISTANCE TO NEAREST WELL 111 FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH n LENGTH 11 DEPTH R <br /> DISTANCE.TO NEAREST WELL it FOUNDATION R PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH tl LENGTH n DEPTII_ R \— <br /> DISTANCE TO NEAREST WELL tl FOUNDATION Il PROPERTY LINE R l/J <br /> ❑ SEEPAGE PITS WIDTH _11 LENGTII_ ___ R DEPTH ____ _11 <br /> DISTANCE TO NEAREST WI.I.I. 11 FOUNDATION R PROPERTY LINE 11 <br /> I HE.REFIV CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE:WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> I STATE:LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �\ NIMUM 24 HOUR ADVANCE NOTICE:REQUIRED FOR INSPECTIONS-PLE.ASE.CALL(NPI)953-7647 <br /> SIGNED ��VI 1 TITLE -/.J �SI'br DATE.QR^93_0 y . <br /> I (II <br /> aP'AY I I y n yr 4"A,� <br /> III <br /> � �x <br /> 1 III � �I It 1 '�a\t <br /> f <br /> —________��I ;off �o�a >e y a r Ib..• L -----/-- <br /> P <br /> AM DRAf <br /> EPARTME.NT ISE ONE.Y / J <br /> Application Accepted By mate-J? �`� Arca— � Employee ID# / <br /> Final Inspection By _ _ - �1DRIB-- 3 <br /> 161 6/ ❑ $PF:('IAI.P.RMI'I'-Appnrvetl by <br /> Character of Soil to Ih of 3 FI: PH/S/ump/Soil Character: <br /> COMMENTS /G AfZ <br /> / L2•�y o.Zr' (`l30') re3 <br /> ' - /;,T <br /> 1'F. SC Received Chec Amount Dale Permit/ Invoice# Permit ID# <br /> Code INro N ash Remilted Service Request# <br /> �• �4b D �o7�7L� <br /> 42.0148)1 ON¢ITF'W 4¢'rFW ATFR PFRAIIT <br />