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ONSITE WAS'��WATER TREATMENT SYST I PERMIT !� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE3s"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 ���/�� /lam -LC�pDI Lha CITY/ZIP <br /> y <br /> CROSS STREET APN PARCELSIZE a.-ULf QC > <br /> /J 0,L l�S3-au—ory <br /> OWNER NAME /S pHJ Y7 � � b?-3 Sya Cij 3 PHONE <br /> OWNER ADDRESS C� n A ��� </y CITY/STATE/ZIP ryiJ�Y✓I L� <br /> T.{ <br /> CONTRACTOR PHONE Ri Si�-5-OZ7 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER S EXPIRATION DATE G <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> b REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0,RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ) NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG &z - CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 9- LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES y0 ft <br /> DISTANCE TO NEAREST WELL ,ASO` IT FOUNDATION �' ft PROPERTY LME ZS-Ot ft <br /> ❑ FILTER BED WIDTH ft LENGTH IT DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R 1y <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R ii3 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R ^_ <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 0 <br /> DISTANCE TO NEAREST WELI` ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL / ft FOUNDATION ft PROPERTY LINE ft <br /> Q]" SEEPAGE PITS NUMBER WIDTH 2L u ft DEPTH Z S ' ft ? <br /> DISTANCE TO NEAREST WELL ft FOUNDATION SD ft PROPERTY LINE ZSd <br /> I 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. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-/PLEA/SE CALL(209)953-7697 <br /> SIGNED TITLE ��n�xoc%c DATE <br /> Af <br /> N <br /> 170 / <br /> J <br /> le. rh <br /> s � <br /> Ik 4C <br /> IQ <br /> 8 <br /> 2U ,1(0 N <br /> I Et VI O <br /> IEA <br /> T <br /> 73 <br />— -- L L <br /> LL <br /> 1 18 <br /> Y <br /> ��/q�/�� DEPARTMENT LIE O LY HEALTH DEPARTMENT <br /> Application Accepted By L.LJ�e' Date S !F C S Area Employee ID# (o[u Q <br /> Final Inspection By >' Date ❑ SPECI EMIT-Apyrovedby <br /> Character of Soil to Depth of Ft: Pit/SDrop Soil <br /> COMMENTS NEw Ll7T or- or 4A _ <br /> le,.ACAW -All <br /> PE S Received / Amount to Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> z.)o Ifs, �7 �o <br /> 15 1 <br /> 42-02-001 Cir .lr� Ll��♦' '-G�! �tl/r�')�, z4&.,,rxSTEWATER PERMIT <br /> 12122/2003 <br /> �t6 <br />