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�f 44p �J`RnIcQ ref g� oyc�000 J <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202 -(20'9)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 1 CITYPZI <br /> Ifl JOB ADDRESS Citi �A!✓l� _ P — y�y� <br /> CADS:.STREET F-��-�'O —`� APN� W, - � <br /> + OWNER NAME PHONE <br /> I � <br /> ! <br /> OWNER ADDRESS C1TVISTATF/ZIP <br /> t <br /> CONTRACTOR _ _ PHONE <br /> CONTRACTOR ADDRESS CTTY/STATEJZIP <br /> l LICENSE 2 ❑C-36 OTHER NUMBER I. E%PIRATtON DATE_ <br /> WATER TABLE DEPTR:— I ac, <br /> 0 FL GEAGRAPHICALIVFORMATION: Coordinates X Y <br /> ❑ PERC TEST n_ I BUILDING PERMIT# .Cd 4" LAND USE APPLICATION Y' <br /> L— <br /> TYPEOFWORK: NEW INSTALIATION ❑ REPAIR/ADDITION ❑ ENC1NEERDESIGNFDIALTER\ATIVE <br /> L] REPLACEMENT ❑ DESTRUCTION— <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNTIS:_ C N�U-M.BER-OF BEDROOMS: / NUMBEROFEMPLOYEFS: <br /> SEPTIC TANK TYPE/MFG_CA,- �tNC.Y�'.T- CAPACITY g.! #OF COMPARTMENIS�_ <br /> ❑ GREASE TRAP h'➢FIMFc ,_,_....._.".._ CAPACITY T___ gal A OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL 11 FOUNDATION ft PROPERTY LINE • ft <br /> ��❑ LIFT STATION SaE TYPE OF PUMP ❑ SAxr,OIL SEPARATOR(ENCLOSED SYSTEM) <br /> q�iLEACH LINES ❑ LEACHING CHAMBERS A OF LINES---�—� LENGTE{OF LINFS�� ft <br /> DISTANCE TO NEAREST WELE �0 Yt FOUNDATIONf�__..R PROPERTY LINE <br /> 7 _ --_ _ _ <br /> ❑ FILTER BED WIDTH _ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ._ft FOUNDATION-..... R PROPERTY LME <br /> ❑ MOUNDED WIDTH_. _fl LcNGTH_ —fl DEPTH <br /> DISTANCE TO NEAREST WELL__ R FOUNDATION _R PROPERTY LME ^ft <br /> ❑ SUMPS WIDTH___ft LF,NG7Hfl DEPTH _ it <br /> DISTANCETONEAREST WELL—.--ft FOUNDATION t1 PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH R LENGTH�— ft DEPTH h <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE_ —ft <br /> / 4C— <br /> SEEPAGEr tt <br /> PITS NI:MBCP�_WIDTH _ tt DEPT <br /> DISTANCE TO NEAREST WELL 1'i !'OL'NDATSON__�,� _ft PROPERTY LINE it >>T- <br /> 1 HEREBY CERITFY THAT I HAVE PKEPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RU S AND REGULATIONS OFS.4N JOAQUIN COUNTY. m <br /> N lyf H VA�'CE E RF.QU7AF.D FOR INSPF.C.TIONS-PLEASE CALL(209)953-7697 <br /> SIGNED / TITLE__r/) n DATE <br /> 7 <br /> I <br /> f - <br /> i I <br /> I <br /> i Li <br /> t5 <br /> 0I <br /> i <br /> DEPARTMENT UE NLY <br /> I Application A"C: I L L --- Dale _ Area _ .__� Ernptoyee IL* <br /> FinallnspecNoR Y Date 6j � 13 SPECT FERMI -.4pprov� � <br /> Character of Soil to p of 3 Ft: p(VSUmp Soil Character:--6 —v lr�esaa��tt++JJ��PP <br /> COMMENTS <br /> L LL <br /> PE SC Received Cbec{JiJ A nt PermjU invoice# Permit 1100::ode INFO I By Cash Remitted Dale Serviee Re vest# <br /> ^ t,, ONSITE WAST <br /> ER PERMIT <br /> 62-02,700 S O V 3`� S*' 2 <br /> 122J:ODJ <br />