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ONSITE WA:: EWATER TREATMENT SYS. M PERMff" <br /> SAN OAQUIN COUNTY ENVIRONMENTAL HEALTH�EPARTMENP 304 E WEBER-3"°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 4100W L. �hq-hvYdtl <br /> 4a0 CITY/ZIP <br /> G -i <br /> CROSS STREET C APN � -d3 D- y PARCEL SIZE /• p <br /> 0 <br /> Ma ni e ca— �rlCil - 17 <br /> OWNER NAME � PHONE 1 <br /> s <br /> OWNER ADDRESS CITY/STATE/ZIP,M/?n-tfCa <br /> CONTRACTOR �/ .(j, PHONE '"/ L�• - / l/ / <br /> CONTRACTOR ADDRESS CITI'/STATE/Zll' <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 ❑ REPAIR/ADDITION <br /> // LIE NEERDESIGNF,D/ALTERNATIVE <br /> ❑ REPLACEMENT E DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> UMBER 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 LINE 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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft \ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 \ <br /> RDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IN 24 HOUR A VANCE NOTICE REQUIRED FOR IN$ ECTIONSS-NPLLEEASE CALL(2 9)953-7697 <br /> SIGNED TITLEY, W/ "�DD� DATE <br /> i w <br /> 1 .31 1 11 <br /> r <br /> 1 <br /> a� <br /> 0 <br /> N','OIJNIIY <br /> u <br /> OLI'Alkl' it IJSL ONLY <br /> Application Al - By Date Area Employee ID# <br /> Final Inspection B, Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to eptth/h��of 3 Ft: t/Sump Soil Character: <br /> COMMS /"�G� �lO _ 1z- P. <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> / Q7S S Vv00• 5 12-'D ip `+,Y )S <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br /> ��� <br />