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/ado <br /> ONSITE WAS7 WATER TREATMENT SYST' A PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D WRTMENT 304 E WEBER Aft"-3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABL PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> '(�-, <br /> JOB ADDRESS n p p LLQ-iii I`r CITY/ZIP 11-B .vnn- C1 Li Z � L <br /> CROSS STREET C rt/l/� '� I� APN O Z- PARCEL SIZE�_�4 .S - a <br /> OWNERNAME �, PIRNEZOq-3Z1- -1271I '1 90 <br /> OWNER ADDRESS 1-4 1 a- Y---%L,---%L, I1 ¢ ..v� P!77 CITY/STATEIZIP U-01>: �F� G1 S_ Z <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS O Z S CITY/STATE/ZIP O <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y A <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#P — ) - <br /> —02 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <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 <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft / <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH R l <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE A <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. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9534697 (V <br /> SIGNED TITLE (iO�ASIn�- �T DATE 5 -V <br /> C <br /> ak <br /> r <br /> UN O N <br /> _ ._ - - - - - HAL <br /> DE RTMENT EON Y <br /> Application Accepted Date Area Employee ID#_c5�"l _ <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 5 <br /> PE SC Received ecidt Amount Date Permit/ Invoice# Permit ID# <br /> Service Re nest# <br /> Code INFO By ash Rem tie <br /> al910 4 2-909 21 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> 1222/2003 — <br />