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L <br /> ONSITE WAS`h WATER TREATMENT SYS1s.4 PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3r°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT / CALL 209 953-7697 FOR INSPECTIONS /�EXPyIIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS G� E �C/ .�r� C[TV/ZIP COAL / G e7 Z v' <br /> y <br /> CROSS STREET E.C�/O // APN 00 2- /36 —/O PARCEL SIZE p <br /> Ei�/rA/Yor �O '/liJu6Jfrr PHONE209-�76f-VZ76 <br /> OWNER NAME <br /> OWNER ADDRESS �/�1+7 r L/�S��Y CITY/STATE/ZIP(Aq[T C."gL <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <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# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> ,rte <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIALq ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: �S NUMBEROFEMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG4261 CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITYgal Is OF COMPARTMENTS <br /> L3PKG TX PLANT DISTANCE TO NEAREST: WELL l 5� ft FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS, ,__ _ #OF LINES-if LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> LIFILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> li. SEEPAGE PITS Numaea X WIDTH 'J R DEPTH �s 1 ft <br /> / ����yyJJuu�� <br /> DISTANCE To NEAREST WELL FOUNDATION R PROPERTY LINE H <br /> I HEREBY CEKJIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> -UU ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMU 24 HOUR NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> D TITLE DATE C <br /> b' <br /> r g� <br /> 1 13 <br /> j J A <br /> ` 14 I. H .EA M .N <br /> I <br /> p PARTMENry T U.sS,EETfL�Y� <br /> Application Acce DateiJ Area Employee ID# �� <br /> Final Inspection Date ❑ SPEC�APERMIT-A proved by <br /> Character of Soil to Depth of Ft: Pit/Sump Soil Character- <br /> COMMENTS <br /> haracterCOMMENTS &LD <br /> Ida CouC`/up - I-FC/C1 -3B•" L C (...e-G Lr. 2 <br /> i <br /> PE SC Received Check#/ Amount Date Permit/ InY*ja2<# - Permi ID# <br /> Code INFO By_ Remitted Service Request / <br /> fD <br /> 42-02-001 <br /> om <br /> iylE AS ATER PERMIT <br /> 170?nnna L� _ �'�-3 ' �' <br />