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ONSITE WASTE`' -"ER TREATMENT SYSTEM' - RMIT�p?� � �0� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPA�A�r 304 E WEBER AVE ,. -3TOCKTON A 952 209)468-3420 <br /> NON-REFUNDABLE <br /> �JPERMIT CALL(209)953-7697 FOR INSPECTIONS EX RES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ( 2 U Al, - 5} CITY/ZIP d <br /> r� A�� � <br /> CROSS STREET 6/ N APN (J�ia�s V'�[�� PARCELSIZE 'O AQ;M— w <br /> " ' /6 A^ v <br /> OWNER NAME >-k.-S {ny ILL/LF, /PHONE <br /> OWNER ADDRESS N7�C� /!/ C �Lt�>L�5 /��A� CITY/STATE/ZIP <br /> CONTRACTOR jt�fL /�Uj �L C nI if . /PHONE + <br /> CONTRACTOR ADDRESS , J. L. �IlI Y / <br /> CITY/STATE/ZIP �jTjJG��+71J/lI C 14 �S S <br /> /' i <br /> LICENSE ❑C-42 L3 C-36 OTHER t!-S-7 NUMBER %7�s C EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST(S) NUMBERLAND USE APPLICATION# /r-D —0, <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 It PROPERTY LINE ft 3 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> b <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE7.O NEAREST WELL tl FOUNDATION sPROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH JH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATI ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATI R PROPERTY LINE 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 R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION (I PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERT Y THAT I HAVE EPARE THIS A LIGATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> TATE WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.f <br /> �M I UM HOU DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> TENTATIVE PARCEL MAP <br /> .R3. .[i. �7� µblA�l(QRI.WtA1NA' <br /> ---------- <br /> % <br /> ------ -- <br /> av " , <br /> 7,f <br /> 7�7 - <br /> iA, i �9 <br /> i c -- re <br /> EPARTMENT SE ONLY <br /> kpplication Accepted Bi '� d <br /> —mate /,� Area f 2— _ Employee iD# <br /> Final Inspection By Date / ❑ SPECIAL PERMIT-Approved by 7� <br /> Character of Soil t Depth t: Pit/Sump Soil Character: <br />�OMMENTS <br /> P977, SC Received Check Amount Date Permit/ Invoice# mit ID# <br /> Code INFO B ash Remitted Service Request# <br /> 2 i 52. /2,2-33 <br /> 12-01-001 �� ) <br /> 212102 c2��, ONSITFiWASPF19AT I <br />