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ONSITE WASTEWATER TREATMENT SY( EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3X0 FL-STOCKTON CA 95202 - (209)468- <br /> NON-REFUNDABLE PERMIT zj0,fj LL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSU, <br /> JOB ADDRESS 4evyL—el-1 CITY/ZIP al t7 <br /> CROSS STREET 45►�!li- �, �. APN QA-()'70--(QA-()'70- J L q .. <br /> � - � - PARCEL SIZE l�..//�ry N ac: <br /> OWNER NAME13,AVo PHONE <br /> f <br /> OWNER ADDRESS 1+ ^, :J I Il:^� - CITY/STATE/ZtP �JI�` r. (7`(y.q.0 (15 ��- <br /> CONTRACTOR ��! 11L51� V r �' PHONE Z647 - .5 •y Y1 t7 . <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP 11 "7 <br /> W I <br /> i LICENSE - ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: f[ GEOGRAPHICAL INFORMATION: Coordinates X .V <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION CI ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCt ❑ COMMERCIAL ❑ OTHER <br /> NUM1tBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> © SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS - <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY pal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �I <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINK ft <br />!� ❑ FILTER BED WIDTH ft LENGTH ft DEPTH - ft <br /> f DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> f 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 t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 8 <br /> 1 HEREBY CERTIFY THAT 1 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL(209)953-7697 <br /> SIGNED L=' _~ / — G.! TITLE DATE { <br /> r <br /> hl <br /> ^I <br /> �I <br /> G� 8 <br /> �i <br /> r <br /> �. -)JI <br /> i i L-Y <br /> N IR(')N E TA <br /> f" EP RTMENT US ON <br /> L II <br /> Application Accepted Date Area Employee ID# ~� r <br /> Final Inspection B ' Da e / ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: ittsump Soil Character; <br /> COMMENTS . / �! <br /> PE SC Received Cfie Amount Date Permit! Invoice q Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42Z'00.1 ONSITE WASTEWATER PERMIT <br /> 1212212003 <br />