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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT, <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 300 E MAIN STREET-STOCKTON CA 96202-(209)4684620 <br /> NON-REFUNDABLE PERMIT CALL 209 959.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE) <br /> • JOB ADDRESS RO CrtrfLP <br /> CROSS STREET 1WI LDWoonAPN 2D3--00—U4' PARCEL SITE -72.q3 qLp <br /> OWNER NAME ✓i� rtlI Son PHONE p <br /> OWNER ADDRESS srN CITYISTATEN21P <br /> CONTRACTGR l R f4 l�60 e 4 4 DRi 5.acrw - PHONE <br /> P':> A-w (e.5S6 CITYISTATERD ,M6A&aNCP+ G�PJ ,IVtT1 <br /> .LICENSE QC-42 QC-35 OTHER NUMER�-q, �EXPIRAl10N DATE 1 =y <br /> WATER TABLE DEPTH: ft GEOGRAPHKALINFORMATION: COOrdinates % Y Flo/ <br /> ❑ PERC TEST R BUILDING PERMIT# LAND USE APPLICATION III <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/AGDTION D EMINEERDESIONEDIALTERNATIVE LA <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICESEPTICS"Inue ❑ DESTRUCTpN <br /> INSTALLATION WILL SERVE: SIDENCE WL❑ ConnueAC ❑ OTHER <br /> NUYBER OF LIVING UNITS: NUMBEROFBEOROCNS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY Bal 110FCOMPARTMENTS <br /> ❑ GREASETRAP TVPE/MFO CAPACITY Bal ROFCOMPARTMENTS <br /> DISTANCETONEAREST WELL R FOUNDATION It PROPERTY LINE ft <br /> O LIFTSTATION SIM TYPE OF PUMP ❑ PKGTXPLANT -.O SAND OIL SEPARATOR(ENCLOSE08YSTEM) <br /> I -� <br /> 6i/IEACH LINES ❑ LEACHING CHAMBERS #OFLINE LENGTH OF LINES 4o' ft... <br /> DISTANCE TO NEAREST WELL, Id,Dft FOUNDATION t ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH fl LENGTH R DEFTN ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ MOUNDED YAM. R LENGTH R DEPTH ft <br /> DISTANCE M NIEAREBT WF11 ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENOPI ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LJ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> • f DIRT CE TO EARES WELL R FOUNDATION R PROPERTYLINE R <br /> SEEPAGE PITS Nu ER- WIDTH B G 61 ft DEPTH 2C-1. ft <br /> DIST ETf1NE T WEL R FOUNDATION�f ft PR ERtt LINE Io ft <br /> 1 HEREBY CERTFYTNAT 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 /> MINIMUMLACE R A VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953.7697 <br /> SIGNED TITLE cG r DATE <br /> I <br /> I EI <br /> E R M in <br /> TZ <br /> I 1 > <br /> DE AR7 E TMI . <br /> Appllcallon Accepted r DateArea Employee IDB <br /> FITIaI Inspection ey - c —/--�� Dela ❑ SPECIAL PERMIT-Approved byCharacter of Sell to Ddpth of 3 Character. <br /> CO NTS 11 <br /> • PE 3C RaCRNwtl Ramktatl <br /> uCk Amount Dela event Involw8 Permit link <br /> Coda IHPO B 9ervica Re uest8 <br /> I <br /> 4241 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> wino <br /> O _. <br />