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ONSITE WASTEWATE�ZEATMENT SYSTEM PERMIT v/ <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE.3-11711.-STOCKTON CA 95202-(209)465-3420 <br /> NON-REFUNDA@ E PERMIT _ CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS C••} VC T�L✓' Apt. CITY/ZIP , <br /> CROSSSTREET I-7 > <br /> APN_ ) 1 PARCEL SIZE f,.�rr j o <br /> tv <br /> OWNERNAME C rr I'-) 4e 1' <br /> ' PHONE <br /> OWNER ADDRESS 7-�I-7 ( kCrC f4J VG• J 4:,,CITY/STATE/ZIP Hm <br /> CONTRACTOR Al,I c . 6 7 .` N ..rte n / X,:,�r S PHONE -' 5`1-c <br /> I <br /> CONTRACTOR ADDRESS ZG �I:��1-1 vi fiA- L`�1, ��,• L�/, <br /> CITY/STATElZIP iJ <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> W?TER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# �l <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 IN OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS X. <br /> y` <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <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 R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION @ ft PROPERTY LINE uu III <br /> 1 HEREBY CERTI THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE-ON tN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINA7VCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN 0AQUIN COUNTY, <br /> 1 M UR ADVANCE NOTICE REQUIRED FOR INS 11 NS-PLE CALL(309)953-7697 <br /> SIGNED _ TITLE .. C I Q ♦ DATE <br /> PAYMENT <br /> RECEIVED <br /> 3- o 0 0 0 0 2`003 <br /> i i I I I i <br /> I P I <br /> I I <br /> I I <br /> IF <br /> I ,w I n.rW.aa�e�vu ma 1' <br /> I <br /> f <br /> �jj DEPARTME T USE ONLY �[p <br /> Application Accepted By�f Date 42-43 Area Employee IDN <br /> Final inspection By Date 13 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received ! Amount Permit/ <br /> /Code I,CFD Byh Cash Remitted 11, Date Service Re uest# Invoice# Permit ID# <br /> 42-01-001 <br /> 12/2/02 ONSITE WASTEWATER PERMIT <br />