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SAN JOAQUIN COUNTY EONSILTEHEAW�LTH c�fEWATER <br /> HTREATMENT SYEM PERMIT <br /> PARTMENT 304 E WEBER AVE -3RD FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE <br /> PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED <br /> JOB ADDRESS ­551,S (--). f o-Ai}6 Q Ao4 O <br /> ,.. � CITY/ZIP ✓�� � <br /> 1 �f� <br /> CROSS STREET =N --0.S.T/k'� APN Q 1 60 + 7„0 PARCEL SIZE /' YV�jA�--l� d <br /> OWNER NAME ,)Oh,)_ PHONE 10q <br /> OWNER ADDRESS did fsrtl�,6 AS ftoye'lItti"TEIC <br /> v <br /> CONTRACTOR iV OG� RT, Z ,3 b Is <br /> 3 <br /> CONTRACTOR ADDRESS D Jf t.J CITYISTATEIZIP IJ <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> PERC TEST # 1 _ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: _ ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER rn <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> i <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 1 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft O <br /> ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) O <br /> r O <br /> D LEACH LINES ❑ LEACHING CHAMBERS b <br /> #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft (1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LZ <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft �'JI <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft d <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 REGU ATIONS OF SAN JOAQUIN COUNTY. <br /> 11'IIN]MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INS .CTIONS—PLEASE CALL(209)953-7697 <br /> SIGNEDTITLEDATE <br /> e.o /,/Z <br /> I <br /> 10 <br /> i <br /> I <br /> i <br /> i <br /> i <br /> N <br /> H V! I <br /> DEPARTMENT U. ON Y <br /> Application Accepted B Date I/ 7 Lf: Arca EmpinD4 �' 7?� <br /> Final Inspection B , ` Date / Z- ❑ SPECIAL PERMIT-Approved by. <br /> Character of Soil to th of 3 Ft: <br /> Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck#1 Amount Permit/ <br /> Code INFO B Cash emitted Date Service Request# Invoice# Permit ID# <br /> 42-02-001 <br /> 12/22/2003 ONSITE WASTEWATER PERMIT <br />