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ONSITE WAST i FRT'VATER TREATMENT SYSTI���PERMIT laid <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPMENT 304E WEBER AV?-+' -STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXP1jtES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I ' 64C 4C f CITY/ZIP P <br /> CROSS STREET APN � RCEL SIZE <br /> OWNER NAME T-a,# e5 `T. 7rt'bKuo r 7 <br /> OWNER ADDRESS -/h(y-0yk CITY/STATE/ZIP Iro✓ <br /> A' • �T✓ <br /> CONTRACTOR t 4jk. PHONE <br /> CONTRACTOR ADDRESS -7 CITY/STATE/ZIP _IT � <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER �d ��` EXPIRATION DATE �3 <br /> WATER TABLE DEPTH: A4zKft GEOGRAPHICAL INFORMATION: Coordinates X Y peri <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAnUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE rn <br /> ❑ REPLACEMENT (3 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: m� <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS S <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS \ <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION R PROPERTY LINE R <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 R FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE L WS AND RULER AND REGULATI N JOAQUIN COUNTY. <br /> M 4 HOUR A ANCE NOTIC REQ FOR INSPECTIONSSS-PLEASE CALL,(209)953-7697 <br /> SIGNED TITLE f/! DATE <br /> 40 <br /> i 1 <br /> � O <br /> T <br /> D <br /> o <br /> 006 <br /> C UN <br /> N IRON 4EN AL <br /> t H H ENT. <br /> DEPARTMENT EON Y-- --- - -- - - -- ---`- - <br /> 3 <br /> C ' <br /> Application ccepted e Z 2� � Area EmployeelD# �.O,p Yry <br /> Final lnspecti B + Date 13ro <br /> SPECIAL PERMIT-Appved by ` <br /> Character of Soil to Depth of nFt: / Pit/Sump Soil Character: <br /> COMMENTS .5- g8rc.-Q, 2 <br /> PE SC Received Check#/ Amount Date Permit/ oic <br /> Code INFO B as Remitted Service Re uest# <br /> Z2 �7a <br /> 79L ' <br /> 42.01.1 7/f, 0 JP 9/-7;k- 7o rR15 S-e- <br /> WASTEWATER PERMIT <br />