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ONSITE WAS7 `NATER TREATMENT SYST I PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DImmRtTMENT 304 E WEBER AVP-*-3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT (CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS I J CITY/ZIP 1 l� Z <br /> CROSS STREET V 1S APN v` 1��Z�5� PARCEL SIZE J�1•a�1 Q��T p <br /> Lt- <br /> r y� ,!5(09- <br /> I nr7�� v <br /> OWNER NAME DLI � Lc,,a Lt-�- E-rA L- PHONE��+'V (0(0.12 <br /> OWNER ADDRESS NDA <br /> (� <br /> • Ct'1 Ci1'CA/> 1�y CITV/STATE,/ZIP � N �,, t . ` ``l2— <br /> V}� <br /> CONTRACTOR 1 D` PHONE �Ui- <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: fl GEOCRAPHICAL INFORMATION: Coordinates X Y <br /> FERC TEST # BUILDING PERMIT# LAND USE APPLICATION# VA-OS�OS4O <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 /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME 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 NEAREL R FOUNDATION f3 PROPERTY LINE R <br /> ❑ FILTER BED WIDTH EN TH ft DEPTH ft <br /> DISTANCE TO NEA EST L ft FOUNDATION ft PROPERTY LINE ft C- <br /> ❑ MOUNDED WIDTH ft LENGT ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ �-SUM.PS • WIDTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fth <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 /> MININIV4 14 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> ,/-P�L'ASE <br /> —CALL <br /> �(209)953-7697 <br /> SIGNED `e !A 1/V" �%�� TITLEU'�/IiL�I/YJ►� �1 I�L✓1 DATE �� y <br /> ULP <br /> 3. L <br /> { 3 <br /> E 'l <br /> I <br /> v o <br /> D P RT E T <br /> i <br /> r, <br /> II. <br /> DEPARTMENT U, ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date �Z 7 d ❑ SPECIAL PERMIT,-Approved by / <br /> Character of Soil to Depth of 3 Ft: Pit ump Soil Character: <br /> COMMENTS <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> If <br /> 42-02-001 ONSITE WASTEWATER PERM IT <br /> 12/22/2003 <br />