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')NSITE W��WATER TREATMENT SY�S �rM PERMIT ` <br /> 'ONMENTALHEAL' EPARTMENT 304E WEAW' E -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> IIT o CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> \ ` CIIT1Y///ZIP <br /> ,O APN ©QJ' I I\j` IO PARCEL SIZE h" I <br /> e K's^ <br /> W IPHONE <br /> Qr2 / I <br /> CITY/STATE/ZIP <br /> �R �T I I�_ F'j L G G'� •. PHONE <br /> &ACTOR ADDRESS CITYISTATE/ZIP <br /> _ICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPMRIADDITION ❑ 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 /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYMM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES I LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL I rO It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE B <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> �� / " ft DEPTH Z� ft <br /> SEEPAGE PITS WIDTH �-'L ft LENGTH <br /> DISTAN TO NEAREST WELL I J O ft FOUNDATION ft PROPERTY LINE It <br /> 1 HEREBY CERTIFY THAT E PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> P Y l <br /> I r� <br /> 20 <br /> b <br /> Z <br /> ------------ <br /> DEPAWMENTIUSE ONLY �'' <br /> Application Accepted B Date .�-Z-�--O Area -1 Z Employee 1D# <br /> Final Inspection BDate ❑ SPECI PERMIT-Approved by <br /> Character of Soil to Depth 3 Ft: PIUSump Soil Character: J <br /> COMMENTS (� <br /> PE SC Received heck# Amount Date PermiD Invoice# Permit lD# <br /> Code INFO B ash Remitted Service Re uest# <br /> x-10 IIS I o 003391:71 <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> 122102 <br />