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ONSITE WASTEWATFSYSTEM PERMIT <br /> `SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1%of 304 E WEBER AVE-31D FL-STOCKTON CA 952*,,A209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS +- i` i.I y l i ,1'.-+_j CITY/ZIP . '. <br /> > <br /> CROSSSTREET C� !��l e• C' ` ' l'-1 APN::i'7 V� *'`� C I PARCELSIZE D <br /> O <br /> kk L I O <br /> T OWNER NAME �' I I I T'i PHONE A <br /> OWNER ADDRESS ! ( ;x CITY/STATE/ZIP t 4,.jr i% C A 1 <br /> CONTRACTOR \i f !- i'� L l f PHONE <br /> �lI, <br /> CONTRACTOR ADDRESS .1 11 'i M', CITY/STATE/ZIP .Ir <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE - <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Q, PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#c i r <br /> TYPE OF WORK: L31 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION - <br /> ` INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> TI 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 /> ` ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LME <br /> ❑ LIFT STATION SIzE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> YAW❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> J <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEsaw R <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 R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> r• <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WD1TN R DEPTH ft <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION - -� R PROPERTY LME - ft <br /> MIND 1 HEREBY CERTIFY THAT I 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC'T'IONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE„'-I DATE <br /> 1W IV <br /> (1 - r!.It I <br /> �I <br /> him <br /> EP R <br /> DEPARTMENT ll,�/E{ONY ' <br /> Application Accepted By -- 1 (- Date I r��7 Area Employee IINi -- I'L� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> OVA <br /> COMMENTS <br /> hog PE SC Received Check#/ Amount ps Permit! Invoice# Permit ID# <br /> Code INFO B Cash Remitted /to Service Re uest# <br /> has 42.02-001 ONSITE WASTEWATER PERMIT <br /> 12/2212003 <br />