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CP°_eNNFll oo <br /> ONSITE WAS' 'WATER TREATMENT SYS'.' �pE�j <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AYf -3N0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT NN��LL CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /� U /WJ U� /` r/CIITTyY/ZIP 6to6x&n, (7s y <br /> CROSS STREET A 1 APN /J 7-l i o_410 nPARCEL SIZE 0?1�2 A <br /> OWNER NAME LTA 1.°F1L[.� �`J�a�MF�fS T/uG• PHONE 7`IG�'llZ�i 1 <br /> OWNERADDRESS (OKa,SrfR RDAI� CITY/STATE/ZIP SfDGK-lar✓ <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinate$ X Y <br /> ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ N EW INSTALLATION ❑ REPAUVADDITION ❑ ENGINEER DESIGNED/ALT RNATIVE <br /> O REPLACEMENT ESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESmeNCE ❑ COMMERCIAL ❑ OT Ea <br /> NUMBER OF LIVING 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 O <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ( ` <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) V <br /> m <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R Y' <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEA WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ]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 /> ,,�1IMIN/I�M�UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED VN� W TITLE DATE QJ' <br /> N <br /> A J ETAS <br /> H E <br /> Ilk <br /> DEPARTMENT US ONLY <br /> Appl <br /> Final Inspection <br /> Accepted By _ Date - 57L� J S Area C_ Employee by <br /> Final Inspection By Dafe D ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth o 3 Ft: Pi ump 1 Character: <br /> COMMENTS <br /> PE SC Received hecldF/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> 0-1 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/222003 <br />