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} <br /> ONSITE WAE {,WATER TREATMENT,SYS"'�VI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3k°FL-STpCKTON CA 95202 - (209)46$-3420 <br /> ', <br /> NON-REFUNDABLE PERMIT CALL(209)953-`7697 FOR INSPETCTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS E �G 4 ( wI 7-,I t fj"-) y CITY/ZIP . = G.;�f Z n <br /> CROSS STREET APN ? 7? a <br /> ff PARCEL S <br /> 1 O ao <br /> OWNER NAME C~+ `-(1�.. +a CJS} TPHONE <br /> OWNER ADDRESS j tl`r" <br /> CITY/STATE/ZIP )� <br /> CONTRACTOR f� s (f ♦ ' C.G(( �� s C 5 r f V r r, c.. PHONE <br /> CONTRACTOR ADDRESS ( OY ) CITYISTATE/ZIP � l e,A <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER ^( LEXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X V <br /> ❑ PERC TEST # BUILDING PERMIT# D 9 5 Lf LAND USE APPLICATION# � <br /> TYPE OF WORK: L12 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ 'E.NGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: YRES1DENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - NUMBER OF EMPLOYEES: <br /> / a <br /> D SEPTIC TANK TYPE/MFG l t- CAPACITY 4 } gal #OF COMPARTMENTS , <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION i ft PROPERTY LINE <br /> © LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> b-.-,-LEACH <br /> ce <br /> b— LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES L Fri ft <br /> DISTANCE To NEAREST WELL t7 ft FOUNDATION )O I ft PROPERTY LINE _� .7 ft .J <br /> ❑ FILTER BED s=WInTH It LENGTH fi DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH <br /> ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fj ,'R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE Tp 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 <br /> SEEPAGE PITS PITS NUMBER TWIDTH ft DEPTH r. ft, <br /> DISTANCE TO NEAREST . WELL { 1(] fi ft FOUNDATION PROPERTY LINE `• ft <br /> I 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 /> MINIMUM-024 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED —(_ �,?r� € t DATE <br /> -- i!•.� TITLE r F'' s C L. <br /> o ' <br /> t <br /> ti <br /> �. <br /> j <br /> ill <br /> �DEPARTMENT USE NLY C�-' <br /> Application Accepted B �!- }' -t :a.- -Date � lbA�ea �P Employee ID# 6, <br /> Final Inspection By F Date ©SPECIAL PERMIT-Approved by ✓✓ <br /> Character of Soil to th of 3 Ft: <br /> At/su;4 5011 Character: <br /> 6 <br /> vim.C fiMh EATS <br /> I <br /> PE SC Received A!Z§§c0e Amount Date Permit/ Invoice PermitlD# <br /> Code INFO B Cash Remitted ,)Service Request# <br /> 1 . <br /> 2/22-00] <br /> 12/22/2003, ONSITE WASTEWATER PERMIT <br /> i <br />