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r r ..ONSITE WACTEWATER TREATMENT SYPRj-EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL— JEPARTMENT 304 E WEB....,AVE-3"°FL-STOCKTON CA 95202 --(209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS -'C1 �l�f��r i�l/ _ CITY/ZIP t Z' <br /> CROSS STREET IJ APN 2 3 ! O _ PARCEL SIZE Z-3 q <br /> OWNER NAME J L•'1 `l` l/� ��+I yL rx _ PHONE <br /> 7 [d- � L.-0 CITYISTATEIZIP <br /> OWNER ADDRESS ��� )n -- <br /> CONTRACTOR .� 4- . ✓r PHONE { <br /> CONTRACTOR ADDRESS U 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# 0 3 0 32-3-!)- LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION © ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY i �b gal 9 OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY ,ti°'' _ gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft j <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 NEARED WELL ft FOUNDATION_ _ft PROPERTY <br /> LINE r ft <br /> FILTER BED WIDTH ft LENGTH ft DEPTH J/I{ 5 ft <br /> DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE ft <br /> I' <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft r <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 <br /> I HEREBY CERTIFY THAT I 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 /> M/INIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNEDI� /L� ��7 TITLE C-yyj J-C-C.4. -CDATE. t 74 <br /> U <br /> E <br /> IN <br /> 7-7 <br /> 64— <br /> N <br /> uta 1 2.8 <br /> 1 <br /> DEPARTMENT U`E ONLY <br /> '54 <br /> Application Accepted By Date (t 4 Area -:ZI Employee 1D# ��' <br /> Final Inspection By Date 4-' 13 SPECIAL PERMIT-Approved by <br /> Character of Soil to D hof 3 Ft: IPit/Sump Soil Character: <br /> 1 COMMENTS Lel�r►�r. d 1Cr�7 L'_.,* � etCer 7 A--t1E- " "IA-) • OF <br /> n 4t, Iq A-T 1J7i4-r til AJ E LJ - 0 F 4-,—&.Cc weA —.<- `,�'s4�FC <br /> I Ifd <br /> PE SC Received eck# Amount Permit/ <br /> Code INFO BY ash Remitted Date Service Request# Invoice# Permit ID# <br /> z rr 117 00 3 -$32-0 PC, <br /> 42-02-001 �J-T ci �7�t.riticC 'O WASTEWATER PERMIT <br /> 12/2212003 !/ <br />