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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1M E.HAZELTON AVENUE-STOCKTON CA 9$205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL f209 933-7597 POR INSPEC nom EXPIRES 9 YEAR FROM GATE ISSUED <br /> Joe J CI yrzw �ic7LJr' <br /> CROSS STREET , .I'/� /��/ ,r1 <br /> f APN �',�,'S � ''S PARCEL SIZE :2 �• � '` <br /> O . � PHONE <br /> WNERNAME � <br /> OWNER ADDRESS CITYISTATEMP <br /> CONTRACTOR ZD-�AtzllPHONE J 1 (J, ,p�yf <br /> CONTRACTOR ADDRESS � A L� - GfTYISTATEMP �.�✓ C..��7 / 7 <br /> LICENSE C-42 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # FTU U DING PEROT# j yrt3 0'3� 3 LAND USE APPLICATION# <br /> TYPE:OF WORK: AC NEW INSTALLATION REPAiWAOMM ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ',j RESIDENCE A COMMERCIAL C7 OTHER <br /> NUMBER OF LIVING UNIT$: NUMBER OF BEDROOMS: NUMBER of EMPLOYEES: ,,,- <br /> SEPTIC TANK TYPE11k1FG CAPACITY ,a P"_ gal #OFCOMPARTMEIT"'r"l ,W. <br /> O GREASE TRAP TYPE/MFG �q CAPACITY ) #OF COMPARTMENTS-- <br /> 7,- <br /> DISTANCE TO NEAREST: WELLL°' ? it FOUNDATION ft ft PROPERTY LINE <br /> ,E3 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT (3 SAND CIL SEPARATOR{ENCLOSED SYSTEM) <br /> %Zl LEACH LINES LEACHING CHAMBERS 'M 0 OF LINES 4� LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL "' ft FOUNDATION �?x _ft PROPERTY LINE <br /> 0 FILTER BED WDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH It LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH. ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> E3 DISPOSAL PONDS MOTH it LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE t2 <br /> E3 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> I HERESY CERTIFY THAT 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, IJ) <br /> MINI 24 HOUR ADVANDE N077CE REQUIRED FOR INSPECTIONS-PLEASE CALL 2U9 953-7$ 7 <br /> SIGNED ./L"-' TITLE DATE , /7,_ <br /> i <br /> f <br /> i <br /> R.Ai! <br /> -1 I <br /> DEPAI7T>4J <br /> Application Acce L v Date 15 Area. Employee iD# ty w <br /> Final Inspection By �F�t:_ <br /> Date SPECIA�rf-Appovedby <br /> Character of Soi!to D pth of 3 "Pitigump Sail Character: <br /> COMMENTS <br /> __._.........._._.._._._......_...... <br /> -.---....__ <br /> PESC Received C Amount Date Pe—W Invoice# Permit 100 <br /> Coda INFO B RernAW S.Mca hest# <br /> J ) <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24112 <br />