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ONSITE W fEWATER TREATMENT Ss EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3k°FL-STOCKTON CA 95202 -.(209)46B- <br /> NON-REFUNDABLE PERMIT 444 1 LL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSU <br /> JOB ADDRESS '06i loo <br /> ` h jrCCITY/ZIP � <br /> V � <br /> �•t i- <br /> CROSS STREET ��;I l`•A iy k �1 APN fJ —07 1- 7'// /27-PARCEL SIZE 3 W Ac: <br /> OWNER NAME _jam i,F'1.A�1-T't� Y1�?^r �1' �...��JLCTS PHONE <br /> OWNER ADDRESS �'(Lr-ry71) ,/, '.J °1).�.l (Vi CITY/STA7E/ZIP,- 4-.L <br /> i CONTRACTOR I 11 V r, .h PHONE <br /> I <br /> CONTRACTOR ADDRESS '!t CITY/STATE/ZIP �i3('• �G �� " <br />' LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> y 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: © RESIDENCE; ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> D SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> i <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 R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELL fl 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 /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> r'? MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE;CALL(20A)953-7697 <br /> SIGNED �' r TITLE DATE 4 <br /> 4^ <br /> t \ <br /> f-- <br /> 7 <br /> �... I VI <br /> 7J 4 <br /> - - <br /> t _ <br /> LLC lip <br /> E - <br /> ,:.,..� - - ,... ,�•n.-� - - - N 112 N E A <br /> EP RTMENT US ONLY <br /> A lication Accepted <br /> PP P Date Area Employee Ip# t, <br /> Final Inspection B Date <br /> 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: it/Snmp Sail Character: <br /> COMMENTS F'2z��� Id 1-4111l <br /> PE Sc Received Che Amount Date Permit/ Invoice# Permit 1D# <br /> Code INFO B Cash Remitted Service Request# <br /> b a )e <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/2212003 <br />