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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE�IISSUED <br /> Joe ADDRESS 3 (S��n'")(� (Z1� CITY/ZIP ��/�i 7 ._ ! <br /> Pu R JA�I� r''TI AP( t�rs r o r q PARCEL SIZE <br /> CROSSSTREET `^I �j�,Lj -{/y��I�• - <br /> OWNERNAME ��/ 'Y^`^�' -�.�^_"-^ f"�- SGr1 P�M/O�NE '��L-C/�� K <br /> OWNER ADDRESS I J 7 r r✓- �• ___CITYISTATEIZIP 11�/'��-7 C 3 0A <br /> CONTRACTOR Central Valley Demolition.Inc PHONE 209-450-8432 <br /> CONTRACTOR ADDRESS 3928,..0...5 Drive _CITYISTATEIZIP Modesto,CA 95356 <br /> LICENSE L- C-42 L C-36 OTHER C-21 NUMBER 901159 EXPIRATION DATE Oi/B4Fe'B'17 r'Z/ y r ZIO I' <br /> WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> PERC TEST # _ ] BUILDING PERMIT#_ _. LAND USE APPLICATION# <br /> REPAIfi/ADDITION ENGINEER DESIGN LTERNATIVE <br /> TYPE OF WORK: NEW INSTALLATION <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE CO M.ERC.AL _ OTHER <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS NU.BER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG _ _ __ CAPACITY _ gal IT OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gai #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R PHOPERT`"I INE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES — LENGTH OF UNES <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE_ elq <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH E�� <br /> DISTANCE TO NEAREST WELL I FOUNDATION ft PROPERTY LINE eo <br /> ❑ MOUNDED WIDTH <br /> (t LENGTH R DEPTH h <br /> DISTANCE TO NEAREST WELL __ft FOUNDATION __R PROPERTY LINE 8 A0� <br /> ❑ SUMPS WIDTH <br /> IT LENGTH It DEPTH-- n L <br /> DISTANCE TO NEAREST WELL It FOUNDATION _ft PROPERTY LINE C�// <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH h DEPTH N COUNT, <br /> DISTANCE 7V NEAREST <br /> rvELL ft FOL:NCA-..rN PROPERTY LINE -- 'fit Hn� N7`4L <br /> WIDTH ft NDEPTH PT4f1 ENT <br /> ❑ SEEPAGE PITS Nu.atH ------ - ft <br /> DISTANCE TO NEAREST WELL _It FOUNDATION_ _ ft PROPERTY LINE __ <br /> I HEREBY 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, <br /> MINIMU 24 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7 97 <br /> TITLE Contractor DATE <br /> SIGNED <br /> --------------- <br /> ---------------- <br /> / / DEPARTM ONLY PA <br /> Application Accepted By <br /> Date � � ODO Area� Employee ID# 1 <br /> Final Inspection By _ __ Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#I Amount Date PermiU Invoice# Permit ID# <br /> Code INFO sh Remitted Sorvice Re u st# <br /> LL <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42.41 1v7��23/ <br /> 4/24712 <br />