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TAL <br />T <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />OWNER NAME --S_. (e ....‹Ci- €: o <br />OWNER ADDRESS P(5) e-_, ox 41 <br />CONTRACTOR Ceoirt i l Vet //:7 ,c:ei,Ae. <br />CONTRACTOR ADDRESS 3 '7 <br />LICENSE C-36 OTHER <br /> NUMBER <br />WATER TABLE DEPTH: <br /> <br />ft <br /> GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST A I - I BUILDING PERMIT # L)7 <br />LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br /> OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: XRESIDENCE COMMERCIAL <br /> <br />11 OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS; NUMBER OF EMPLOYEES: <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 ISSUED <br />JOB ADDRESS 67 -Li 34IF 7' <br />icA QI/4 CROSS STREET APN <br />(2--f— <br />oc.) 7 C S-0 LI 7 PARCEL SIZE <br />CITY/STATE/ZIP <br />PHONE <br />PHONE <br />42,3 .D <br />.5-09 7 <br />CITY/STATE/ZIP —CA' /..-4 (1L <br />EXPIRATION DATE (7 /31 /4-)/) 01(10V :41l f)PI SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG (r-fli1e47 . frt <br />TYPE/MFG <br /> <br />CAPACITY <br />CAPACITY <br />FOUNDATION <br />gal <br />gal <br />ft <br /># OF COMPARTMENTS z•-• <br /># OF COMPARTMENTS <br />PROPERTY LINE A."10 ft <br /> <br />DISTANCE TO NEAREST: WELL 7 O6 ft <br />LIFT STATION <br /> <br />SIZE TYPE OF PUMP <br /> PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />i LEACHING CHAMBERS A OF LINES <br />DISTANCE TO NEAREST WELL AC:7° i 71— FOUNDATION 1/43 ' ft PROPERTY LINE VO / ft <br />WIDTH ft LENGTH If DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE If <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION If PROPERTY LINE If <br />WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TOrAREST WELL 1I FOUNDATION ft PROPERTY LINE If <br />\Fir SEEPAGE PITS NUMBER 3 1 WIDTH 1,7z 2 /, ft DEPTH c..;),irc / ft <br />DISTANCE TO NEAREST WELL /5/'f- ft FOUNDATION ?..;',I1 ' 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 />MINIMUM 48 HOUR ADVANCE OTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2091953-7697 <br />a. • <br />1111111111111111 <br /> <br />A <br /> <br />L;) <br /> <br />t-t <br /> <br />PA <br />LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br /> LENGTH OF LINES 5 ft <br />SIGNED <br />! <br /> TITLE ,1S^Y t DATE / <br />Num <br />ommmum um= mourso • II Ns <br />U. <br />MEM WEI <br />DEPARTMENT use ()An.), <br />Application Accepted By Date <br />Final Inspection By Date SPECIAL PERMIT - Approved by <br />, Character of Soil to Depth of 3 Ft Pit/Sump Soil c4practer: <br />COMMENTS ;2epi,f6 oil cyc tfol "rie r 1, ad k frias nui bee PI <br /> <br />:ThE . 1,, be deolo I , sh(cLalckr &Lao 0 5 eoic pe Y011 <br />S oaa s— <br />PE <br />Code <br />SC <br />INFO <br />Received <br />A By a/ <br />Check*/ <br />sit _r_ <br />Amount <br />Remitted Date PermiV <br />Service Request * Invoice tt Permit ID* <br />c-;Izo H 7 <br />( <br />Are. qi(fr• Employee IDA 'PA <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114;18