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ONSITE W - TEWATER TREATMENT S1 -TEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468=342e <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR.INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> L/►T ��!� .".JTY/ZIP <br /> / 'L) 3 <br /> CROSS STREET C �' �7 _ APN z— — h' <br /> s <br /> V PARCEL SIZE d <br /> OWNER NAME I � � p <br /> 5 <br /> sj PHONE <br /> OWNER ADDRESS v C� * , r IL <br /> CITY/STATE/ZIP v <br /> L 1� I.23 <br /> CONTRACTOR - <br /> . <br /> CONTRACTOR ADDRESS CITY/STAT£/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />, Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: <br /> ❑ .SEPTIC TANK TYPE/MFG <br /> CAPACITY.. gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> 13PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION <br /> ft PROPERTY LINE I} <br /> 13 LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR <br /> (ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #oF'L1NE5 <br /> LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION. ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft <br /> ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTHft <br /> ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH' ft' LENGTH ft DEPTH - ft <br /> DISTANCE TO NEAREST WELLft <br /> ft FOUNDATION. ff PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft <br /> DEPTH <br /> DISTANCE TO NEAREST —ftWELL tt FOUNDATION <br /> ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft <br /> I HEREBY 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. <br /> MINIMPM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSP <br /> SIGNED ECTIONS-PLEASE C LL(209)953-7697 <br /> r <br /> DATE <br /> r <br /> 7 <br /> r <br /> J A <br /> U <br /> _ q t <br /> DEPARTMENT SE ON <br /> Application Accepte Date 40 Area <br /> Employee[D# <br /> Final Inspection Date d' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 F Ft: Pit/Sump Sail Character: <br /> COMMENTS l� 7 <br /> x <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Remitted Date Service Re ue t# Invoice# Permit ID# <br /> IL <br /> \42-02-001 <br /> /2003 ONSITE WASTEWATER PERMIT <br />