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ONSITE WA` ?EWATER TREATMENT SY� ",MPERMI19CAN ',t 430 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTI.,r.PARTMENT 304 E WEBER rl:JE -3" <br /> 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 t? 1 r\`" { r CITY/ZIP OL <br /> CROSSSTREET APN ,ZS, 30 p S ARCELSIZE <br /> OWNER NAME C S h PHONE 3 y <br /> OWNERADDRESS J,'!i tP Q jr, n' � S' CITY/STATE/ZIPy, <br /> CONTRACTOR PHONE J "3 ! <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP ! <br /> I <br /> i <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# a-i <br /> TYPE'LOFWORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNEDIALT Arllt <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE © COMMERCIAL ❑ OTHER <br /> NUMBER OF LI VING UNITS. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS i <br /> } <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> W <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft r� <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 /> i <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <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 R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HERESY CERTIFY THAT I 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. ex <br /> MINIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED- TITLE� ��� -.�� DATE <br /> T <br /> E <br /> SIE <br /> F 8 . <br /> 5" g A a <br /> 7L EP M NT <br /> i <br /> DF.PARTMFN. C _Q I . �. ,• _-. � <br /> ' A ication Accepted B �"---�� Date' <br /> RP P Y 1 I n Z CrS Area Employee ID# `Y'�C'C� �c/ <br /> Final Inspection By Date 1 (r b3 ❑ SPECIAL PERMIT-Approved by - e _. +�alp '1 <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: t�� d , . '�`�pi►"1 =�;. j f I <br /> COMM <br /> ,NTS ./O 5 a -i = 7Esr` iti d' <br /> L)V1 + <br /> PE SC Received hec Amount Date - Permit! invoice# Permit ID# <br /> Code INFO By__ Cash Remitted Service Re uest# <br /> 0 QO Q jro <br /> i <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />