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aniHgi scan .0-0-7 #m <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT IN <br /> jv3o '/Y <br /> -SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205U9)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 20 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Q Crry/ZIP C(/ <br /> CROSS STREET A�� 1 APN �J / /J (S PARCEL SIZE �Tp <br /> OWNER NAME TT77 �G —1 PHON9r'�25--2-iZ�x7" 1T,-7 g <br /> N <br /> OWNER ADDRESS '30i Lmz <br /> (' CRY/STATE/ZIP <br /> CONTRACTOR ��wI "&, /� z t +CVC/` PHONE �7NJ 3 <br /> CONTRACTOR ADDRESS &G YZ'/NI01'6P/r� �/1 CITY/STATE21P ✓/ 5�� <br /> LICENSE ❑EC-42 ❑❑C-36 OTHER A NUMBER_[Lu ZJ1 EXPIRATION DATE l / 'x�'j 72 <br /> WATER TABLE DEPTH: -2-0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT II OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE & COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: /� / 2 L NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> L3T/7'• <br /> J �-v <br /> SEPTICTANK TYPEIMFG UbALA CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES �, LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ill FILTER BED WIDTH 2 I ft LENGTH--�� <br /> G��T�H� ..������ ,3ft e-/ DEPTH � ft <br /> DISTANCE TO NEAREST WELLPO9ft FOUNDATION ! z;' ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINft <br /> [3 SUMPS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY 1-1131:C91 % ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH�ry�pRp ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE /'` LQu ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH SAID UIAIft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPEFIRONMEN.ir IV"n_TM ft <br /> c17 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 814610ii <br /> STATE LAWS AND RULES AND REGUL TIONS OF SAN JOAQUIN COUNTY. <br /> MINIM 24 HOUR ADVANCE NOTICE RE( OR INSPECTIONS-PLEASE CALL(2091953-7697 ^� <br /> SIGNED 410— TITLE e!2x 'r DATE V- <br /> 14 <br /> S�_q; T I <br /> 3 <br /> 110'2- <br /> FF <br /> `I O <br /> Q- <br /> _ <br /> DEPARTMENT U.SE DAILY <br /> Application Accepted By _ __ D='eYJ Area Employee iD <br /> #TlZid S <br /> Final Inspection By ate El SPEC L PERMIT-Approved by <br /> Character of Soil to D h of 3 F. it/Su p Soil Character: <br /> COMMENTS yam, <br /> KYM�-= I L f1C�L ��h14/1 <br /> 1 P SC Received Chec Amount Date PermiU Invoice# Permit ID* <br /> Code INFO B s Remitted Service Re rest# <br /> 2 6& 3Gd n E�oo 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />