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ONSITE WAS,., WATER TREATMENT SYS',,,—VI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3ND FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS / <br /> � EXPIRES1 YEAR FROM DATE ISSUED <br /> 1;4 <br /> JOB ADDRESS /�� 1 �T f�aLrf'i DINE CITY/ZIP ;CIPa��( 9S7?3/ ,� <br /> A /� w ��77 ��/`� —J m <br /> CROSS STREET _SAV S 7?tJ 20A 6 APN O'�pZL��g'Q^QS PARCEL SIZE Z S <br /> 0 <br /> Irl a 0 <br /> OWNER NAME /'Yf C{ CoPn^�OD/Tl EE 5 PHONE 6-7!5-- 2( 5' <br /> OWNER ADDRESS ` •C� Olt ( [ CITY/STATE/ZIP <br /> CONTRACTOR G �� �'C-LT PHONE 0 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 2• 's ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST #_ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: El RESIDENCE LJ COMMERCIAL 13 OTHER <br /> NUM <br /> BER 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 III 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 LME 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 /> I HEREBY CER FY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> DINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �11N*1 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS//-PLEASE CALL(209)953-7697 q <br /> SIGNED TITLE�liyNA!FA DATE <br /> Arm <br /> AN J0IAQPlNICQUNTY <br /> ENV1HU\IM-11J ALT <br /> Ft Ize <br /> ccNLYDEPARTMENT SE� <br /> �.pplie&t:ort Accepted ByCate �= �� �c area 2niptoyee ID» -lll — - <br /> rlFinal Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO By emitted Date 'ervice Request# Invoice# Permit ID# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />