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ONSITE WAS%rCWATER TREATMENT SYS1rKM PERMIT <br /> s SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -34"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE`PERMIT CALL(209)953-7697 FO INSPECTIONS EXPIRE1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I CITY/ZIP <br /> /— 7 > <br /> CROSS STREET / APN — �/V — Q PARCEL SIZE <br /> OWNER NAMEPHONEC �/ �� <br /> TOWNER ADDRESS /�/s� r4td�� CITY/STATE/ZIP H <br /> CONTRACTOR �-s��Z.� -��y��t� C�� PHONE <br /> TCONTRACTOR ADDRESS t� CITY/STATE/ZIP _ <br /> LICENSE -42 ❑C-36 01HI-:K NUMBER � EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> U PERC TEST(S) NUMBER LAND USE APPLICATION# �) <br /> TYPE OF WORK: ❑ NEW INSTALLATION ACREPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ 0'1-11ER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: f2 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY_ gal #OF COMPARTMENTS _ n <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS —J\ <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) `r <br /> "l <br /> LEACH LINES LEACHING CHAMBERS #OF LINES �_ LENGTH OF LINES 7'� ft <br /> / <br /> DISTANCE TO NEAREST WELL D ft FOUNDATION C,+� ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE,PAYIVIr-I[V-rI It <br /> �❑ ��[._D MOUNDED WIDTH ft LENGTH ft DEPTH RECEIVED ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH n 'I /i► (% J ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTHSAN JGAQul,%4 COUN <br /> _ Pini !1417!4 CCR\!If L C ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYfA'It+1 .-' � "I11 LA 41-Al Tli P`."� t <br /> SEEPAGE PITS WIDTH 'lam ft Le oFr— f/t DEPTH A.< 1t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION �JV ft PROPERTY LINE l �� tt <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 LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IMMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20099)953-7697 <br /> SIGNED � Y � TITLE '(� "//fJ/ DATE 3 e <br /> d <br /> ob <br /> i <br /> v <br /> i <br /> S i <br />