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ONSITE WASTEWATER TREATMENT SYSTEMPERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH V-#ARTMENT 304 E WEBER Av�E -3,°FL-STOCKTON CA 95202 - (209)468-3420 <br /> \ <br /> NON-REFUNDABLE PERMIT 7, `'CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS -30 L" r -2- CITY/LIP <br /> CROSS STREET 64� (� 2 f a <br /> APN �1 . ��/�- J�v PARCEL SIZE <br /> OWNER NAME ��I-Sv P110NF; � <br /> � - 7-- <br /> v y <br /> OWNER ADDREss �1 CITY/STATE/LIN <br /> CONTRACTOR /� �r'v --�` / <br /> 1/ PHONE <br /> CONTRA(-rOR ADDRESS CITY/STATE/GIP A. / L `\ri <br /> LICENSE '-42 LIC-36 0`1 HER NUMBEREXPIRATION DATEi J Aj <br /> WATER TABLE.DEP'lIt: / D Il (:FOGRAI'll I('Al.INFORMATION: ('oordinates X _ 1' <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INS'T'ALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Nt'\1BER OF EMPLOYEES: <br /> f' <br /> ❑ SEPTICTANK TYI'E/MPG------- --- — CAPACHY - gal #OECOMPARLnILNIS <br /> ❑ CREASE TRAP TYPE/MPO CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DIST'ANCF,TO NEAREST: WELL tt FOUNDATION R PROPERTY LINE it <br /> 0 LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1 v <br /> ( LEACH LINES LEACHING CHAMBERS Z[a7/� #OF LINES f;C LENGTH OF LINES Z-/, t't <br /> DISTANCE.TO NEAREST WELL f�tib ft FOUNDATION ySr ft PROPERTY LINE <br /> ❑ FILTER BED WIDTD ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ftO LI ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft PTH - It <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONfl O I ft <br /> ❑ SUMPS WIDTH_ ft LENGTH fl DEPTH ft <br /> DISTANCE'r0 NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION (l PROPERTY LINE ft <br /> SEEPAGE PITS Nun1Br;R Wlnru /f � II DEPTH S fl <br /> DISTANCE.'rO NEAREST WELL. J ft FOUNDATION 2i— ft PROPERTY LINE 5 It <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTI' <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 HOUR ADVANCE NOTICE:RF.QUIRE:D FOR INSPEC ONS-PLE.ASF.CALL(209)953-7697 <br /> 'ICNE;D �/ y-`?� 6'L ` 'r.i .-RD'I'ITLE f'�7.-=''�—� DATE 4�4/1'l 111r'.5 <br /> 06 OEM <br /> 1 14 <br /> 6 <br /> 1 <br /> V <br /> GV <br /> DEPARYMAT USE O 'LY <br /> Application Accepted By e d Area DatEmployee IDN <br /> Final Inspection BV Date � 11SPECIA PE MIT-A roved b <br /> PP Y <br /> Character of Soil to Depth o 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> � o <br /> PE SC Received r Chec Amount mi <br /> Code INFO By \ a. I Remitted to Service R4 vest# Invoice# Permit ID# <br /> z i2oo /9 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12122 200 <br />