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ONSITE WA' -EWATF/-"7REATMENT SYF-EM PE RRMIT ' 6�1�/1}�! <br /> E _ f <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTx- EPARTMENT 304 E WEBEI,.vi:-3-FL-STOCKTON CA 952D. Z09)468-34 0 <br /> 1. NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR I INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 161-1 ~ CITY/ZIP <br /> -1 <br /> CROSSSTREET U' APN `/1f� l 7 PARCELSIZE <br /> OWNER NAME PHONE <br /> OWNERADDRESS �%Wj'//4� CITYISTATEJzdP <br /> CONTRACTOR +� PHONE <br /> CONTRACTOR ADDRESS CrrYISTATE/ZIP O V <br /> LICENSE C42 0C•36 OTHER NUMBER EXPIRATION DATE AP- lt`I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ` <br /> ❑ PERC TEST # BUILDING PERMIT# O�Wlqy LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ 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 TYPEIMFO �` &-4 CAPACITY V O gal #OF COMPARTMENTS_ <br /> ❑ CREASE TRAP TYPFIMM CAPACITY gal 9 OF COMPARTMENTS <br /> U PKC TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION_ ~_ ft PROPERTY LME �cJ O R <br /> ❑ LIFT STATION SIzE TYPE PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYYSSTEM) <br /> LEACH LINES Imo-LEACHING CHAMBERS f4 OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCETO NEAREST WELL ft FOUNDATION A ' PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH ft I D�*TH ft <br /> DISTANCE TO NEAREST WELL ft ^OU AT[Oy 11 " PROPERTY LINE ft <br /> I� 51 <br /> SUMPS WIDTHa ft LENGTH / DEPTH ft <br /> DISTANCE TO NEAREST WELL Q_- FOU TION i D ft PROPERTY LINE <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAOUITS NUMBERWIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> I 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 /> MI MUM 24 HOUR VANC �TtC4 REQUIRED FOR INSPE NS-PLEASE CALL(209)953-7h97 <br /> SIGNED d2-TITLE DATE D <br /> ITI <br /> La <br />