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4, <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HFJLLTH DePARTMENT 1868 E.HAZELTON AvENuc-STOCKTON CA 45205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS LUr�T CITYrzIp ';7c---T`C,,,' i '> <br /> CROSSSTREET APN 1 7-) PARCEL SCM c� <br /> 05tJNER NAME_ C�•t 11lIC' (i`liLiyl .r'I` PHONE <br /> 1 <br /> OWNER ADDRESS YAW CITYISTAMZP <br /> CONTRACTOR TL C_ C:JC_�t C.,T:IY�/?) i E�(J t iZ. IyJ( PHONE &4' LII Z, % <br /> CONTRACTORADDRESS.0�+ �7 YJ7('r'{�SSI' L' c .Lc L I•: J:t. CrTYISTATEIZIP i'CIIo, <../tu ib"/e <br /> i <br /> UCSNOE 'C.42 C-36 OTHQR NUMBBR�f��'y��r EXPIRATION DATE &11-3_O11eZ-O <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST X BUILDING PERMIT# LAND USE APPLICATION# <br /> O WORK NEwIN3TALLAT70N REPAIRIADOmON ENGINEER OE310Ni51AL7ERKATrvE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM ✓ DESTRUCTION rJ';r7- 7T;4,. <br /> INSTALLATION WILL SERVE: 'RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> O SEPTICTANK TYPEJM=c CAr>,1ei gal /#C:CCMPARTAICNIS <br /> ❑ GREASE TRAP TYPFIM.--G CAPa r; gal #C=COMPARTMENTS <br /> DISTANCE To NEAREST: WILL R FOUiCAT0% It PROPERTY LINE ft <br /> U LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #CF LNEs LENGTH OF LINES ft <br /> DISTANCE TO NEAREST V.'L!L ft FOUNDATION r PRC4'ER7Y LINE ft <br /> ❑ FILTER BED WIOTH ft LENGtH ft DEPTH ft <br /> DISTANCE TO NEAREST V:F.L, ft OUNDATIC?J R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH fl Lr:NGTH ft Da-PTH <br /> Wft <br /> DISTANCE TO NEAREST ELL ft ;7,DUNP.ATICN _ R PRCPERTY LINE R <br /> ❑ SUMPS WOTH ft L=NGTH ft D".PTH R <br /> DISTANCE TO NEAREST WELL ft rJUN AIIUJ ft PROPER-YLINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH R DFPT,I ft <br /> DISTANCE TO NEAREST Y:1_LL ft FCA1P:^,ATICf: ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NumarR WIDTH ft DEPTH R <br /> DISTANCE TO NEAREST WFLE. ft :GJNVA71CN It PROPER Te LINE R <br /> I HEREBY CERTIFY THAT l 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 /> _`U"401"QUP ADVANCE N077CE REQUIRED FOR T72NS-PLEASE CALL(209)953-7697 <br /> SIGNED / —=tom ~ TITLE 'r r:' DATE 0', /1`f' i"", <br /> O�0 <br /> 1 177 <br /> 77 <br /> NT <br /> t <br /> DEPARTMENT USE ONLY ll <br /> � [J i <br /> ,Application Accepted �� Date S /�{ Zi? <br /> . ZO Area � shCEmployee ID# LA <br /> Final Inspection By Date El❑ SPECIAL PERMIT -Approved by <br /> Character of Soil to 7 f F : Pit/Sump Soil Character: <br /> COMMENTS LL -1 (✓��OjE MNi� 3�Si 1L4L GO&) / 1ft_Cb-_*>J�11�cT rc��7 oIM Dw U,LNt? <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> yaa l 075 <br /> 4 (l�/'N ' 7-1 <br /> l UO S /tO Z. ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14//14/18 <br />