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r ".4 ' <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAEN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7$97"FOR INSPECTIONS / EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS�� [�,ES1/?Ll!CJz _ p_-CINIMP <br /> CROSS STREET D,VU/S _APN �Y— 0 —0 PAROELSRE <br /> OMERLNAME Ill PHONE N <br /> OWNER AODR"S ITY/STATE/ZYP _ <br /> CONTRACTOR PHONEZG <br /> _ . ' : <br /> 44 <br /> CONTRACTOR ADDRESS Ile,rtar+r/�y /JJjr/,'� CITY/STATEIZLP { <br /> LICENSE IhC-42 ❑C-36 OTHER + :NUMBER yC Y/Jy EXPMATION DATE <br /> 07 I-lo <br /> ` f <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> E PERC TEST # BUILDING PERMIT# 0 S 0 1 b-20 LAND USE APPLICATION# 3f <br /> TYPE OF WORK: Al NEW INSTALLATION Ll REPAIR/ADOITION ❑ ENGINEER DESIGNED/ALTERNATIVE 1` <br /> r REPLACEMENT ] DESTRuc-nom -1 <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE X COMMERCIAL ❑ OTHER - 11 <br /> NUMBER OF WIN¢UNITS: F] NUMBER OF BEDROOMS: n NUMBER OF EMPLOYEES: <br /> (jI- SEPTIC TANK TYPElMFG CAPACITY_ IJ_�__ gal #OFCOMPARTIJENTS �1 <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENT3 <br /> DISTANCETONEAREST: WELL _ It FOUNDATION ft PROPERTYLINE • 4�2, It + <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR{ENCLOSED SYSTEM) <br /> Ilk LEACH LINES LEACHING CHAMBERS F #of LINES LENGTH OF LINES - ft <br /> DISTANCE TO NEAREST WELL �•�r It FOUNDATPON6+ ft PROPERTYLINE <br /> ❑ FILTER BED WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE: fl <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL H FOUNDATION ft PROPERTY UNE It �I <br /> ❑ SUMPS WIDTH R LENGTH A DEPTH ft Ih-+ <br /> DISTANCE TD NEAREST WELL fl FUUNDATIUN ft PROPERTY LINE It <br /> q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE To NkAREST WELL ft FOUNDATION ft PROPERTYLINE ft I <br /> U SEEPAGE PITS NUMBER WIDTH ft DEPTH ft. <br /> DISTANCE To NEAREST WELL R FOUNOATION ft PROPERTY LINE fl <br /> I <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE� _ DATEJ�Z x1a� <br /> - <br /> PNIM <br /> NTY <br /> UQ N AL <br /> Fj <br /> T DENRUIeff <br /> A <br /> 41 <br /> i <br /> I 5 <br /> I � <br /> _ a _ <br /> BEPAR71MEN7-tl F_ON Y-_ _ _ <br /> Application Acceted Bb � Data o 9' Area Employee lo# 5310 Gq 9 <br /> Final Inspection 0818 <br /> �o('�� dfi IJ SPECIAL PERMIT-Approved by <br /> Character of Soi, <br /> j;.p�t8h. <br /> fFT: Pit/Sump Soll Character: <br /> COMMENTS z--AA ,_ �,7u+y,¢c me �i.t�uG w�cr- S �7 iAGl[S . <br /> 7 - - ( ' <br /> PE 1 SC Received Amountpate PermlU # Permit <br /> Code INFO B Cash Remitted Service Re uest# <br /> 112 g zsv <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 174107 <br />