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A,, <br /> ONSITE V ;TEWATER TREATMENT SYSTEM ' 'RMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL Hbp.,.41 DEPARTMENT 304 E WEBER AVE-3" _WSTOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES1 Y O I DATE ISSUED <br /> JOB ADDRESS 111.0S1 e-(-A,M CITY/ZIPL' �J' a <br /> CROSS STREET AU-11>-LA�/ AFN �,�TJ D q2_� PARCEL.SIZE <br /> OWNER NAME M 2 /{rqCGAtM()I71TI E5 , SAIL 'I <br /> PHONE o?D�I 5rI <br /> OWNERADDRESS P.D, -6C>)[ �7# ,/ CITY/STATE/ZIP mope.-2 T CFT <br /> 45353 <br /> CONI RACrOR qo I>---,T-.o �/#Aj b ?7 C�7 el v4 E/- Ale_ PHONE�9 --"-'5--4.41 I Z-1 <br /> 4 <br /> CONTRACTOR ADDRESS IJ7 /-/'4 A4 [�� g � /-6 <br /> CITY/STATE/ZIP dZIDEt'T14.4 �IL <br /> LICENSE ❑C-42 ❑C-36 OTHER G/ NUMBER EXPIRATION DATL ZZq <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL IN FORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMDER LAND USE APPLICA'T'ION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION Cl ENCiNEER DF.SICNF,D/ALTERNATIVE <br /> ❑ REPLACEMENT �DFSTRUCTION �E�'r)l _, <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: rn <br /> ❑ SEPTIC TANK TYPEJMFG CAPACITY gal #Or COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal #Or COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL _ fl FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TVPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL. R F'OUNDA'TION R PROPERTY LINE it <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION_ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTN R LENGTH It DEPTH Il <br /> DISTANCE TO NEAREST WELL. fl FOUNDATION f1 PROPERTY LINE __ R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH_ R <br /> DISTANCE'IO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION tt PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)933-7697 -.I <br /> SIGNE J-a('� TITLE FYILuI' DATE U <br /> h <br /> 4t I 1 1-7 1104 <br /> V p N O <br /> 0-ow E <br /> uti O <br /> jEj <br /> LO <br /> 14 L't e4 a 47+ <br /> r <br /> / PARTMENT SE 'LY <br /> Application Accepted By Date Arra� Employee IDN <br /> Final Inspection By Date �O ❑ SPECIAL PERMIT-Approved by <br /> Character Of S011 to De hot Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Chec .Amount Date Permit/ Invoice# Permit IEW <br /> Code INFO By Cash Remllted a ucsl <br /> 07i 22.72 g (• /7 0 8`M(� <br /> 42-01-001 <br /> 122/02 ONSITE WAS'rEW ATTR PERMIT <br />