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znrh'a1 scan j1/3//u <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)469.3420 <br /> NON-REFUNDABLE PERMIT CALL 2093-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS CmrlLP C,� _ <br /> Y <br /> CROSS STREET I`..I,;* A } a,A,,PN-Z_�Z,{ —�/0- 0 PARCEL SIZE <br /> OWNER NAME L �F d E�L(I tI 1�t 1 T PHONE a�-Z <br /> SOYFIffR ADDRESS ef, CITY/STATE/ZIP <br /> CONTRACTOR rvl+I4-{IS 43 PHONE 161 <br /> CONTRACTOR ADDRESS L`S. CITYISTATEILP <br /> LICENSE C42 C-36 OTHER NUMBER IS E%PWATKNI DATE_ ��_ <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST IT BUILOING PERMIT# LAND USE APPLICATION alt <br /> TYPE OF WORK: NEW INSTALLATION EPAIR/ADDTnON ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: fJTESIDENCE U COMMERC OTHER <br /> NUMBER OF LIVING UNITS: i _ NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG _ CAPACITY gal Y OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY ___ gal NOF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL It FOUNDATION It PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS N OF LINES�_ LENGTH OF LINES �,l It <br /> DISTANCE TO NEAREST WELL -1-kIf —ZIP' <br /> FOUNDATION_-�� it PROPERTY LINE Vl_ _It <br /> ❑ FILTER BED WIDTH h LENGTH R DEPTH T it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LIVE it <br /> ❑ MOUNDED WIDTH K LENGTH it DEPTH'—� It <br /> DISTANCE TO NEAREST WELL K FOINIOATI N K PROPERTY LIN <br /> ❑ SUMPS WIDTH it LENGTH _N DEPTH it <br /> DISTANCE To NEAREST WELL It FOUNDATION IT PROPERTY LIN '• it <br /> /�)�� <br /> ❑ DISPOSAL PONDS WIDTH h ,�LENGTH it DEPTH 54.. �u10 It <br /> DISTANCE TO NEAREST WELL it FOUNDATION H PROPERTY IL aoI •n fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH h DEPTH IiEAL1H IIE NiAIit <br /> DISTANCE TO NEAREST WELL N FOUNDATION h PROPERTYLINE '"'Alk-owr it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 /> MINIMUM 24 HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �T�Qz TITLE L 1 'I 1+c'f J I DATE t 1 <br /> TTFFf - - - - -- -- -- — - - <br /> 1 <br /> t - - - - - <br /> D PA T FE T S Y <br /> Applica6G-I Accepted _ -- _ Ietc (� _ A`ea �-- F.mrAoyae IDN rf 0tkV�s <br /> Final Inspection By <br /> 1 <br /> Character of Soil to lh of 3 Ft: Pi umo Soil Character: <br /> COMMENTS (t-D <br /> PE SCI Received heck# Amount Date <br /> PermW Invoice N Permit IDN <br /> Code INFO B Remitted Service Re ueet N <br /> 0 I rC I ZIA 172 <br /> 42-01 ONSITE WASTEWATER TRTMNF S'STEM OFRMIT <br /> 424/12 <br />