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ONSITE WAST„TATER TREATMENT SYSTL..PERMIT /ago <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3'"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 19t `CITY/ZIP <br /> CROSS STREET "1 ` APN ��� 1 O �, PARCEL SIZE .4LDf-S p <br /> OWNER NAME DGv1 a 1J aUY1-<- <br /> PHONE <br /> OWNER ADDRESS 11'Atoy CITY/STATE/ZIP2/�, <br /> CONTRACTOR INCA PHONE UI-3-7(ol <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 77 BUILDING PERMIT# LAND USE APPLICATION# <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 /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft \' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft 1� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> x <br /> 1 HEREBY CERTIFY THAT 1 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 INSPECTIONS-PLEASE CALL(2-09)95377697 <br /> SIGNED TITLE Gbvy Rti�-F-otn�� DATE Z 1 O <br /> / -3.17 3 $ <br /> 1 5.13 0'°L ! 2 2; Za 2 3 R — L 3 2 y o <br /> / ' Pv 0 / 0 5 :0 .6 3 2r — <br /> til � s s <br /> Z 3 a <br /> 1 1 l Ito <br /> 2 a <br /> 4-7 i0c) 100 <br /> r <br /> 1 O <br /> S <br /> 1 I3 8 <br /> / L a <br /> ti N p <br /> S v( p M E <br /> DEPARTMENT USE ONLY ►1F�LT [� <br /> Application Accepted �� Date /?J/�QL Area Employee ID# / g <br /> Final Inspection B Date�`���Q� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 P,U's S it Character: <br /> COMMENTS -ti <br /> PE SC Received Check#/ Amount Date Permit/ Invo' a Permit / <br /> Code INFO B Remitted Service Request# <br /> 9V 1 v 'flys L; 1; 0 Roo D'.13 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />