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ANN ' <br /> ONSITE WAS WATER TREATMENT SYSTAM PERMIVW <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH I _:RTMENT 304 E WEBER-11 i, _,,-3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(20`9)9.53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> �v <br /> JOB ADDRESS Y=l rl V �:. } R I crau Li CITYIZIP r-elc M E Z U <br /> CROSS STREET � GG�(0/� iSe-1katL'c APN t(67" 1-1,o-10k PARCELSIZE a 4G; :,S <br /> OWNER NAME l- mnL. - PHONE _264-4, 7 Cj Z?G — d <br /> � <br /> OWNERADDRESS CITY/STATE/ZIPC-A '-Z.3 <br /> CONTRACTOR ��i Ir,A ddi.,rpky „-,,,,,, PHONE 21- t `loco <br /> CONTRACTOR ADDRESS Pr Zo W 1 ti�G(��e. ,� Sy, C- G CITY/STATE/ZIP o �i�¢ �S'Z`•) <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: `/ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> LKPERC TEST(S) NUMBER .y LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRJADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: . ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVtNG 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 <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEP BATOR(ENCLOSED SYSTEM <br /> : ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TU 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 U <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D SUMPS WIDTH ft LENGTH ft- DEPTH ft t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> EI SEEPAGE PITS WIDTH ft LENGTH ft DEPTHft <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 ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24"OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> I SIGNED TITLE f'.Kv far^ DATE !S/04- <br /> k <br /> � 1 <br /> N <br /> Cj <br /> AV YU� P <br /> S 1 <br /> Z <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date �+' Area Employee ID# <br /> Final Inspection B _ DRte�,ry;/ -" T �✓ <br /> t p Y _ _ �.� T.9=1/1� - - � SPECI:41;`PER1V11'1'=Appioved by <br /> 01-2 de-i 4 Soil to Depth of 3 Ft: PitlSump Sail Character: <br /> COMMENTS 1-7 1 <br /> PE SC Received Ghec Amount Date Permit/' Invoice# Permit ID# <br /> Code INFO B Cash Remitted rt Service Re uest# <br /> (0 c51N`©u Lt g 0(0 r3 <br /> 42-01-001 <br /> 1212/02 ONSITE WASTEWATER PERMIT <br />