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!OD ONSITE WAST NATER TREATMENT SYST I PERMIT- <br /> S QUIN COU ENVIRONMENTAL HEALTH DFWRTMENT 304 E WEBER AV 3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP P. - <br /> CROSS STREET 1 I� 1 G APN 051 ' Q 1 R PARCEL SIZE 'C S O <br /> OWNER NAME DaV I( �(�UI�'C D 1,nPlH11OCNEE1n�S147,57 C 2 N <br /> OWNER ADDRESS toy�r-c�r�evJ�n t`� CITY/STATE/ZIP v'y v1�+r�+ n � 516 <br /> nI 2(� 2 T <br /> CONTRACTOR I CA PHONE JV/�� -70 1 <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'S"J1 Nz'` '' <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ,, v,r*:fgkl <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> • •:air, <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ll LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1 <br /> 12x,: 'V1 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINE§t" ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R (~� <br /> LI FILTER BED WIDTH ft LENGTH fl DEPTH ft `J <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 LME R ''"' <br /> i <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft \I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 't`�`filvj <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 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft <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:. i ''61.*:" <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697. <br /> SIGNED TITLE Gd.n� DATE I 1 O <br /> n o .O � .l l 3.r7� �•- 3 $ �1 <br /> 1 j 34 5.3 D, <br /> � ; / D g 71 :o t r _ <br /> l 3 s �`. s <br /> 2 a <br /> p06o 0 <br /> 1 I Ilv <br /> Ir— <br /> O <br /> -44 1 1 A, 1 1 1 1 <br /> AA e F 11E <br /> S <br /> 3 B <br /> n y f <br /> / 9. S4 5 ti <br /> � � N O <br /> O M E <br /> DEPARTMENT USE ONLY H�L� <br /> t � Date /yf/� Area EmployeeJD# gg <br /> Application Accepted d3 <br /> Final Inspection B Date���.��QS ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 Pit/Sump S it Character: <br /> COMMENTS t;�- oti /z Z a <br /> PE SC Received Check#/ Amount Date Permit/ Invo a Permit I <br /> Code INFO B Remitted Service Request# <br /> �2 zz <br /> 42-02-001 /.� O SI ASTE TER PERM T o <br /> /2�y d 5 y�y� �}-2 >���xuc� •-res a Viso-t.i�./`_ji�/�i- . `�ou�vl,�'T <br /> 1212212003 <br />