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' I <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQLIN COUNTYENVIRONMEVTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(20)468-347,0 <br /> PION-REFUNDABLEPERNUT li 340(- CALL 209 953-7697 FOR INSPECTIONS EXPIRES IYEAR FROM DATE ISSUED <br /> JOB ADDRESS IG ap3l tc, 916 <br /> CROSS STREET _ APNr v/O p[� PARCEL SIZE <br /> OWNER NAME wok )k Fl-eKwa— / PHONE 64"y/)-7 7P— <br /> 5i <br /> Vg Ir-1 91(1144- oe44' <br /> OWNERADDRESS //)) �j ,y) _ CrrV/STATEIZ/IP I <br /> CONTRACTOR d"ll,P 2 j /�/G�/l2&, PHONE /�� -'S. <br /> CONTRACTOR ADDRESS !?Oa^/�.g;, vd C1TYISTATLMP ell, !� ✓� <br /> LICENSE ❑ C42 ❑ C-36 OTHER NUMBER EXPIRATION DATE <br /> I <br /> WATERTABLEDEPTH: ft GEOGRAPHICALINPORnfATION: Coordinates X Y <br /> FERC TEST N BUILDING PER.'MIT# LAND USE APPLICATION# y �L <br /> TYPE OF WORK: C1 NEW INSTALLATION 0 REPAIRIADDiTION 0 ENGINEERDESIGNED 1ALTE.RNA IVF, <br /> O REPLACEMENT 0 DE5RtUC1GN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE O COMMERCIAL O OTHER <br /> !NUMBER OFLnT,1GUNITSc NUMBER OF BEDROOMS: NUKWAOF EMPWYEES: ' <br /> ❑ SEPTICTANK TYPE(MFG CAPACITY gal NOF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal N OF COMPARTMENTS <br /> DISTANCETONEAREST: WELL R TOINDATTON ft PROPERTY LINE ft <br /> ❑ LIST STATION SIZE TYPE Of P13IP 0 PKC TX PLANT ❑ SAND OIL SEPARATOR(EV CLOM SYSTEM) <br /> O LEACH LINES Q LEACHING CHAMBERS #OF LNES LENGTH Or LIVES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O FILTER BED WIDTH ft LENGTH_ R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH_ ft DEPTH R Y I <br /> DISTANCE TO NEAREST WELT, ft FOUNDATION R PROPERTY'LINE ft <br /> Q SUMPS tt'mTH ft Lo;GTS ft DEPTH ft <br /> DISTANCE TO NEAREST %VELI R FOUNDATION ft PROPERTY LINE ft TM 1 <br /> U DISPOSAL PONDS WmTB ft LENGTH ft DEPTH ft 1+�1 <br /> DISTANCE TO NEAREST WELT, it FOUNDATION ft PROPERTYLINE R <br /> ❑ SEEPAGEPITS NumxER WmTR ft DEPTH ft <br /> DISTANCETONE-4RSST WELL ft YOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 14 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION P/EASE CALL(209)953-7697 <br /> SIGNED TITLE 7FI DATE <br /> vs <br /> -44 <br /> D <br /> 11 t <br /> i 1 <br /> � Y <br /> _? i <br /> c 6N0 <br /> a <br /> i <br /> DEPARTMENT UW OpLY <br /> .App11c3fiwn Accepted By Date �� Ara EmplDyee IDN �7 <br /> Final Inspection By ` Date ie& ❑ SPECIAL PERMIT-Approved by I <br /> Character of Soil to Depth of 3 Ft: Pit/Samp Soil Character: <br /> i <br /> COMMENTS F 1 =7'. G+ - a s .4 WA'v+ ito. <br /> �GIf?mlr�1 I <br /> PE SC Received he Aafotlat Date Permit/ Invoice N Permit IDN <br /> Code INFO By Cash Remitted Service,R uest# I <br /> -4 Z:ZZ S'L I <br /> i <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 05l30/2DD7 <br />