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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SCANNED <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3X0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS / <br /> CITY/ZIP <br /> y <br /> -` "' tf <br /> CROSS STREET APN -/-7/—/'70-/3�®^/.� PARCEL SIZE <br /> OWNER NAME <br /> PHONE <br /> OWNER ADDRESS /c7 p I 0 C. - I �-�`� <br /> //�� <br /> CITY/STATE/ZIP {� <br /> CONTRACTOR �O.4 �../L< 6 p" Z11L, PHONE Ia FD 0 Q <br /> CONTRACTOR ADDRESS ' ¢ r• I e / CITY/STATE/ZIP S-Z� <br /> LICENSE ❑C-42 ❑C-36 OTHER [_-�J NUMBER !o Lf EXPIRATION DATE Q S <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ EN NE R DESIGNED/ ERNATIVE <br /> LJ REPLACEMENT ��DESTRUCTION I�IC 1 T� <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROF EMPLOYEES: <br /> l <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS oQ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST' WELL ft FOUNDATION ft PROPERTY LME ft !� <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) t 1 1 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH f} <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM 24 HOLt ADVANCE NOTIqE REQUIRED FOR INS ECTIONS-PLEASE ALL(209)953-7697 <br /> SIGNED TITL i - .✓DATE <br /> r• <br /> 4 ) 1 1 1 1 TF <br /> I t <br /> E <br /> DEPARTMENT USENLY <br /> Application Accepted By Date 6 Area Employee ID# <br /> Final Inspection By ' /✓ Date 1� /�! 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> Gia lZO P A G 7L4- 7L4 <br /> JAAt t �! <br /> PE SC Received Chech#1 Amount Date Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> v 74- ,Z <br /> 42-02-001 ONSITE;WASTEWATER PERMIT <br /> 12/22/2003 <br />