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ONSITE WA ,EWATER TREATMENT SYS EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT.75EPARTMENT 304 E WEBEIV90fVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 1303 s. Hlsq/99 <br /> CITY/ZIP <br /> /YJKA,7V SCA CA 4533 <br /> CROSS STREET FREVC44 e-AAIP _4b APN (mfr/�' ©/Ci"t�VTqzl <br /> PARCEL SIZE DC o <br /> �-gyp�-�/ <br /> toWNER NAME 2I�TT�FZE�-�-/ F• �C�J ��RTNG���I�(� PMH O�NF./ �!t'l �0r�t23�0 I O U <br /> OWNER ADDRESS I��C7I S f-IT.uTQ 9 CITY/STATE/ZIP A14A)71�_ex <br /> CONTRACTOR 0 CJJAJ&YL PHONE 8� --01 0 <br /> CONTRACTOR ADDRESS 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# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT DESFRU ION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> LJ SEPTIC TANK TYPE/MFG CAPACITY # tE0 PARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY F rdC 1 RTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE <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 R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <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 R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 /> MIN'IM1 1 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Lff1il/YLGt� DATE - �• C� <br /> + ? <br /> I t <br /> e <br /> ia, ... <br /> t <br /> F I VE <br /> + k.... <br /> i� <br /> f <br /> , <br /> i <br /> :. ..., EP R <br /> F <br /> 1 , <br /> e 1 <br /> f <br /> I <br /> 1 y._._ /. .j� � ... <br /> -H <br /> i+ <br /> 549 <br /> Application Accepted By '� Date AreaEmployee ID# <br /> Final Inspection By :te _ ❑ SPEC!AL PEP.NIIT-Approved by <br /> Character of Soil to Depthof3 Ft- 1;21—"Pit/Sut-fip Soil Character: <br /> COMMENTS f�/� �j/� f, X/ ��•i1/� f1/�%Gs ,1�� <br /> PE SC Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Re uest# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />