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ONSITE WAS7'EWATEY- TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIHONMENTA I.HEALTH DEPARTMENT 304 E WERF,R AYE-31'FI.-STOCKTON CA 95202. 4t09)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)951-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM'M*rE ISSUED <br /> Jon ADDRESS 1 <br /> CITYlZIP / ' '(',�_�� � a <br /> ,ylUS IC ILC I APN l l _�}� y <br /> CROSS STREET ` vim' _1 ~��� PARCEL SI'/.t: � <br /> OWNERNAME �[ -1���X 'I�, (j y-%��/� /( PHONE— <br /> `' <br /> OWNER ADDRESS �J CITYfSTATEIZIP t�IJ[PlyCONTRACTOR - � PI{ONE _ } - i <br /> C. CONTRACTOR ADDRESS I '7 CITY/STAT <br /> LICENSE ❑C-42 L)C-36 OTHER NUMRER EXPIRATION DATE: <br /> WATER TABLE DEPTH: Fl C,EOGRAPHICAL INFORMATION: Coordinates X I <br /> I V <br /> t PERC TEST NBUILDING PERMIT# LAND USE APPLICATION <br /> 11 TYPE OF WORK: ❑ NFWINSTAI,I,AT10N LJREPAIRlADDITION ❑ ENGINEER DESIGNED IgLTERNATIVE r1" <br /> ❑ REPLACEMENT ❑ DESTRUCTION �. <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAI, {] OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUNIBF,n OF EMPLOYEES: <br /> C1 SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gaI #OF COMPARTMENTS <br /> 1 <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL R FOUNDATION R PROPERTY LINE- <br /> it / <br /> C3 LIFT STATION SIZE TvpE OF PUMP LlSAND OIL SEPARATOR(ENcLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WFI'I. R FOUNDATION R PROPERTY LINE Ij <br /> ❑ FILTER BED WIDTH fl LENGTH Fl pLPrx <br /> DISTANCETONF.AREST WELL R FOUNDATION R PROPERTY I,INE p , <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELLR FOUNDATfON fl PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE Fl <br /> ❑ DISPOSAL PONDS WIDTH_ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> CI SEEPAGE PITS NUMBER Wlonl R DEPTH Fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION H PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TH15 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 /> 41N. IMUM 24 HOUR ADVANCE:NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED \V-�. —�� <br /> TITLE DATE <br /> i <br /> 1 r <br /> N O N7 <br /> V1 O 1J <br /> EAT _ I <br /> i <br /> DEPARTMENT U E O LV- <br /> Application Accepted _ 4� Date GSc `s� <br /> Area 2-1 Fmpioyec 1D# - <br /> Final Inspection By �� '} <br /> Dale f/_..�1[.��_ 0 SPECIAL PERMIT-Approved by q <br /> Charaeter of SDII to Depth of 3 Fl: Pit/Sump SDii Character' - <br /> COMMENTS <br /> ' 'z7 <br /> PE SC Received Check#1 Amount ( Permit/ <br /> Code INFO B emitted Date Service Request# Invoice# Permit ID# <br /> !moi <br /> 42.'a S7{ Y 3,DL) .P0(11 0�CJ <br /> 42-02-BD I _ <br /> ONSI"I'E WASTEWATER PERMIT <br />