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} ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 14 <br /> `SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Ave -3""FL-STOCKTON CA 95202 - (209)46H-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS AA, I Z ( _ _ ,'- +~\2!�,)_Lam.- CITYI'LIP -Z7]rC Z-7 Cy <br /> CROSS STREET _ F.r J"' p A P N i� j C7-7— PARCEL SIZE '7.7 <br /> rn <br /> 11,'r �ia I --4/•`I''`_S /� PHONE <br /> OWNER NAME _ <br /> OWNER ADDRESS agf <br /> {� CITY/STATE/Zl P <br /> CONTRACTOR 2 zn /�'+J- PHONE •�S y7 — 3 <br /> CONTRACTOR ADDRESS CITYISTATE/Z•IP G�r < ,f 4— !� �r-? <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE r t/ <br /> WATER TA BLE DEPTH: ll GEOGRAPHICAL INFORMATION: Coordinates X Y C <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# J�� <br /> TYPE OF WORK-. -W NEW INSTALLATION ❑ REPAIRIADDYI-ION ❑ E\GINEERDX;SIGNEDIALTPRNA'I'IVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMRRCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NLMM�BER OF BEDROOMS: NLNIBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 4:�2:,[_^e .z I, C CAPACITY !�'C' V gal #i OF COMPARTMENTS _ L_ <br /> ❑ GREASE TRAP TVPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TQC PLANT DISTANCE TO NEAREST: WELL / �~� f ft FOLNDATION �c] f fl PROPFRTY LINE ef ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSFEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINF.s �-3 LENGTH of LINFs it <br /> DISTANCE TO NEAREST WELL /5-0 it FOUNDATION ft PROPERTY LINE -3 ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH Ff <br /> DISTANCE TO NEAREST WELL ( FOUNDATION ft PROPERTY LINT; R <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ Sumps WIDTH Ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft IIROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROIIERTY LINE ft <br /> -a SEEPAGE PITS WIDTH 5 ft LENGTH ft DEPTH (l <br /> DISTANCE TO NEAREST WRIT --,2-30 -ft FOUNDATION_�� _ft PROPERTY LANEft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WI7T1 SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED i TITLE -. /��LJh+C� DATE <br /> l <br /> C If 4a-A <br /> QIrILa <br /> Le <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Dale Area _ Employee 04 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO 8 Cash Remitted Date Service Re ucst# Invoice# Permit SD# <br /> a <br /> 42-01-001 <br /> IV2/02 ONSITE WASTEWATER PERMIT <br />