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z vti <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLE <br /> y PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 513(0 W 6S;r ww 17 CITYILP 1:-06( gSLYZ <br /> A <br /> CROSS STRAIT Ft-AFH- APN 0,-S-/60-73 PARCEL SEE 4-a g <br /> 0 <br /> OWNERNAME F(nl.lu gLe(Or� PHONE 3'1'1 '2112 <br /> OWNER ADDRESSSAm?, .% 'A bDY(- CITY/STATEESP LODT CA <br /> CONTRACTOR WEST Ci M)f %AGKNOE , IrJL PHONE y� <br /> CONTRACTORADDRESS '�' D PDY p332 CITYISTATPRIP V1(--rbf CA OTSjLS� <br /> LICENSE QC42 ❑C46 OTHER A NUMBER BSIIIJ_I EXPIRATION DATE r)l/ <br /> L <br /> WATER TABLE DEPTH: A GEOGRAPHICAL INFORMATION: CeOMIBetea X V <br /> ❑ PERC TEST M BUILDING PERMIT# �-O 0 ( LAND USEAPPUCATION# <br /> TYPE OF WORK: V NEWINSTALLATION ❑ REPAIRIADDITID ❑ ENGINEER DESIGNED IALTERNATNB <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICESEPTICSYSTEM ❑ DESTRUCTION <br /> INSLLERVE: 11 RESIDENCE COMMERCIAL ❑ OHER 7J <br /> J UNITS: Ct NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: t <br /> tl SEPTICTANK TYPE/MFG V41. \'LOO CAPACITY 1100 gal #OFCOMPARTMENTS Z. <br /> ❑ GREASETRAP TYPVMFG rAPACITY Bal #OFCOMPARTMENTS S <br /> DISTANCETONEAREST: WELL It FOUNDATION N PROPERT'LINF. It G-C <br /> ❑ LIFTSTATION SIZE TVPEOFPUMP U PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO <br /> �NEAREST WELL R FOUNDATION B PROPERTY LINE It <br /> Ml FILTER BED va. -•TL 73//L B LENGTH -MiB-' �o� G ft DEPTH R <br /> DISTANCE TO NEAREST WELL I❑LT L R FOUNDATION J It PROPERTY LINE 101 II <br /> ❑ MOUNDED WMTH ft LENGTH 6 DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION-11 PROPERIYUNE It <br /> ❑ SUMPS VIOOTN It LENGTH a DEPTII ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY I INE ft <br /> ❑ DISPOSAL PONDS MemH ry LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER Mon, ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE T 'R <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL/2091 953-769 <br /> SIGNED TITLE TCEII.VD`N r DATE N'17--1010 <br /> y <br /> I CL _ — <br /> y <br /> rl- I <br /> I <br /> wa � <br /> 1 IR kYI IIE NIT <br /> NOV <br /> i O INC V <br /> M Mm <br /> P 'LA T E <br /> -� <br /> P AppliwDon Accept//etl �. <br /> s Dated— /O Brea Employee ID# -�9� 7g <br /> Final lnapeclion B4' Data 7/ �j. El SPECIAL PERMIT-Approved by <br /> Character of Soil to D-?1h of 3 Ft: Pit/Sump Soll Character: <br /> COMMENTS IaS'f �EcbucLur.w SE.T8+4cE'S' - <br /> PESC ROaeivetl heck#! ve#Amount Oate Pelml6 InvolPermit ID# <br /> Code INFO Remittetl Service R uSell <br /> 2.162sa dZ S2s.od !I r Si�ao(o! 5 <br /> 42-01 - ONSOE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9EIM <br /> L <br /> 1Mt <br />