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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 (����� ALL(�220.�9)953-7$97 FORINSPEGTfONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRCS ------ <br /> 'j ---443 CITY1z;P <br /> CROSSSTREET {"��/ � �_ <br /> F _APN 13moog PARCELSIZE 3013S o <br /> OWNERNAME- 157-- 3 Ljit C> <br /> 1 �f y�} PHONE <br /> OWNER ADDRESS 7 . 1r�aor�WLjf� jive CRYISTATE/ZIP 1�?rkjje« gs337 <br /> 1 <br /> CONTRACTOR,_ N\11 5_. 6 4! II( PHONE�y��r��•�Cs`� C� <br /> CONTRACTOR ADDRESS � •--d_�D J CRYISTATE/ZIP ffl�MJ��C, <br /> UCENBE DLC-42 ❑UC-36//��07NER tom" NUMBEREXPIRATION DATE <br /> WATER TABLE DEPTH:__ V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT'# P-) S LAND USE APPLICATION# <br /> TYPE OF WORK: V NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED ALTER <br /> 0 REPLACEMENT - 1'1 OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCiq, ❑ OTHER— <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK 7YpC/MFG_�t�-_-, �, CApACIT•Y—L _- 981 #k OF COMPARTMENTS_,,,__„_ <br /> O GREASETRAP TYPUMFG CAPACITY _ gal #OFCOMPARTMENTS <br /> DISTANCE T ._-� <br /> O NEAREST: WELL2— it FOUNDATION '6 —� -,_ it PROPERTY UNE -1.51 <br /> Ft <br /> 0 LIFT STATION SIZE ­—TYPE OF PUMP_ .❑ PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> U LEACH LINES 0 LEACHING CHAMBERS,._, #Dr-LINES _ LENGTH OF LINES _ It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft. PROPERTY LINE_ �-ft <br /> FILTER BED WIDTH_� y__ft LENGTH�Z it -- DEPTH ��3 r _�y it <br /> DISTANCE TO NEAREST WELL —_ft FOUNDATION lam` ft PROPERTY LINE ft <br /> Ia MOUNDED WIDTH i ft LENGTH it DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _...it PROPERTY LINE ft <br /> nJ SUMPS WIDTH ft LENGTH __.._.__.Ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ it FOUNDATION_____ft PROPERTY LINE_ ft <br /> Q DISPOSAL PONDS WIDTH ft LENGTH.�._ __ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL— It FOUNDATION ft PROPERTY UNE ft <br /> C� SEEPAGE PITS NUMBER WIDTH—_- ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION Ft PROPERTY LINE it <br /> I HERESY 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 Ott HOUR A DVANCE NOTICE REQUIRED FOR INS��PEC`�TIO,NS-PLEASE CALL 209 53-7897 <br /> SIGNED ._ _ TITLE `+�A / <br /> '-.r.P OLO r DATE <br /> —I <br /> I <br /> I <br /> i <br /> _ I <br /> y DF_PAR7MPN ,USE ONLY <br /> Application Accepted By - 'yC. ►r Date r�� c�r3�_ Arae 7 J, E=mployee IDI✓ S — <br /> Final Inspection By _ k- 7�•—.._._fc.�lA+L...____-- DRte. .0 SPECIAL PERMIT Approved by <br /> Character of Soil to Depth 3 Ft: aT PRISUntp Soil Character: <br /> COMMENTS Alet,J feff <br /> PE SC --r Recely®d ec! Amount Date Permitl Invoice# Permit ID# <br /> Code Iwo By as Remitted Service RS nest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />