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9� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT y <br /> SAN JOAQUIN COUNTYENVIRONMENTAL 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 f U �CX/{- ✓��J ey CITY/ZIP G I, <br /> CROSSSTREET APN D 2�-02-0-02- PARCEL SIZE T^�4 D <br /> OWNER NAME �UN /Y(�rI�L[(l/✓)/, PHONE `y <br /> OWNER ADDRESS6X-1"� /!� /t��(K C/ 'CITYISTATE)ZIP <br /> CONTRACTOR /` [ C PHONE <br /> CONTRACTOR ADDRESS ✓u CITYISTATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> I <br /> I WATER TABLE DEPTH; _ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> f ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# ' <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> LII REPLACEMENT DESTRUCTION - <br /> I INSTALLATION WILL SERVE:. ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> '0111SEPTIC TANK TYPEIMFG CAPACITY gal #0 FCOMPARTMENTS <br /> ❑ GREASE TRAP I TYPE/MFG i CAPACITY gal #OF COMPARTMENTS_ <br /> ❑ PKC Ti PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TvPE OF Pump ❑ ,SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl <br /> ' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE . Il O <br /> (3 FILTER BED WIDTH ft LENGTH fl DEPTH 11 (� <br /> DISTANCE TO NEAREST WELL - R FOUNDATION ft PROPERTY LINE ft r\� <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL It FOUNDATION fl PROPERTY LINE _ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl <br /> I DISTANCE TO NEAREST WELL it FOUNDATION _ft PROPERTY LINE _ fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft Z <br /> - DISTANCETO NEAREST WELL ft FOUNDATION .. it PROPERTY LINE n R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH .l ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE 11 <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> iORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M NI!1 2 HOl1R ADVANCE NOTICE.REQUIRED FOR INSPECTIONS SPI EASF:CALL(209)953-7697 J�J'j' <br /> SIGNED TIT .-Q DATE J-30_02 <br /> �.Jll 11 n hill <br /> ` IN Opt4ly <br /> If E VI O <br /> I <br /> r2 <br /> y <br /> 01:�� <br /> �-.DEPARTMENT,U E_O.Application Accepted lY/ Date 3 3� 0 LL Area � Employee ID#Final Inspection B Dote e��/ 7 - C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth oPltlSump Soil Character: <br /> COMMENTS <br /> G7� :!w— <br /> SC rrYX-� c�e+'cY/J.'iY, 5 <br /> 1 PE C Received Check#/ o Amount Permit/ <br /> • Date- Invoice# Permit ID# <br /> Code IN <br /> �B Remitted Service Re uest# ` <br /> I ,c <br /> q-Z-ZL 'O�.s LJT) tot? (JlJ l� 5 <br /> 42-02-001 - - - ONSITE WASTEWATER PERMIT <br /> 12/2212003 <br />