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:, -�� Ily <br /> ONSITE WAS WATER TREATMi NT SYS' 'M PEAW NNED <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH-DEPARTMENT 304E WEBERVE FL-STOCKTON CA 95202 - 09)468-3420 <br /> NON-REFUNDABLE PERMIT C LL 2091 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS .'e,/ 9 CIT�YJ/ZII-/Pr FF-� "64'I �t f� <br /> CROSS STREET /' StJ4 N / // O l PARCELSIZE 4� //C• o <br /> OWNER NAME12M1211 33q-31i>1 <br /> PHONE <br /> E . <br /> y'7 C.} ' LVVI; RS2u1� <br /> OWNER ADDRESS � � 1�.. 7l VJ'P GJ/ SISI CITY/STATE/ZIP <br /> �,t * I <br /> CONTRACTOR 7 3e PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> 1 <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# ztdE <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAHUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE Uf COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> •❑ SEPTIC TANK TYPE/MFG CAPACITY gal .#OF COMPARTMENTS <br /> 'y,�y/ ,, f9q Y�Ve�i +l <br /> AL asREASE TRAP rYPFJMFG CAPACITY �/I�OF COMPARTMENTS _ <br /> YJ <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPE OF Pump Q,l- 5 D OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS G"Ail:�OF LINES LENGTH OF LINES <br /> DI ANCETO NEAT ^T LL R FOU JDATION ft PROPERTY LINE fl <br /> ❑ FILTER BED WI Tx EN TH �r7i, /! ! ft DTH` ft <br /> DI •--�- E T ^L R FOUND TION /I�-�rFYRTY L) ft <br /> ❑ MOUNDED WI Try ,"--J--- ft ft �/!DE_PITH' f ft 6 <br /> DI ANCE TO NEAR WELL FOUND TION V/i[""��R <br /> ❑ SUMPS W TH R LEND ft DEPTH ft <br /> DI ANCE TO NEA WELL ft FOUNDATION ft PROPERTY LME it <br /> ❑ DISPOSAL PONDS DTH H <br /> D ANCETONEARES WELL ft FOUND TION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS N WIDTH R DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> 1 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. \7 <br /> r 1 U C R ADIVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)97697 r A 9 ^ <br /> SIGN J`XA <br /> ® e <br /> ED <br /> D I <br /> 210 5-00011 194 S=00011 200 S-0,0011 <br /> I � <br /> TANK <br /> TRAILER ' <br /> £ y <br /> 2 0 <br /> zts sa0.0011 ® 190 s.0.0011 ® 202S-a❑011 <br /> —SAND,/04.:SEPARATOR.,.DESIGN BY <br /> I <br /> II VIII A o>yNL II <br /> ITh I FIDSTWG STORM INWN POND sz'JO'0 <br /> DESIGN FLOW- 14.0 aF.S. s.p,mz0 <br /> SANJiIN <br /> Application Accepted By Date '[ S Area ENVIRLSri <br /> Final Inspection By Date I SPECIAL PEIMEIMSbWRWWW�AENT <br /> Character of Soil to Depth of 3 Ft: PluSump Soil Character: <br /> COMMENTS <br /> PE SC Received Ch / Amount Date Permit/ invoice# Permit ID# <br /> Code INFO Cash Remitted Service Re uest# <br /> X01 <br /> ONSITE WASTEWATER PERMIT <br /> 42/22 <br /> 12/22/2003rz/201 <br /> ool <br />