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IP30 /p/c.cS- <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"°FL-STOCKTON CA 95202 -(209)468,3420 <br /> NON-REFUNDABLE PERMIT <br /> /J CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSLED <br /> JOB ADDRESS /�67j�`� „TfTT <br /> APN 1011'—_ CIFTY/ZIP <br /> CROSS STREET /,J Iu 0^/ PA RCEL SIZE SZ AC j <br /> OWNER NAME �`�P/���1� PHONE <br /> OWNERADDRESS /J CrrYISTATF/ZIP <br /> CONTRACTOR /C L - PHONE <br /> CONTRACTOR ADDRESS CITYlSTATE/7.IP <br /> LICENSE. 42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST #_ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION4rRFPAIRJADDn-ION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ..RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUatRER OF BEDROOMS: N[iMBF.R OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARIMEN'TS <br /> ❑ GREASE TRAP TYPE'MFG— CAPACITY gal #OFCOMP.ARTMENTS <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE - TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED St'STEM) <br /> uk LEACH LINES ❑ LEACHING CHAMBERS #OF LINES I.FNGTH OF LINEST ` R <br /> i l 1 <br /> DISTANCE TO NEAREST WELL �p^� ft FOUNDATION �� ft PROPERTY LIME �O-f ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH It L) <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft R7 <br /> ❑ MOUNDED WIDTH —.—R LENGTH ft DEPTH ft o <br /> DISTANCETO NEAREST WELL _ R FOUNDATION ft PROPER FY LINE ft <br /> Cl SUMPS WmTx R LENGTH ft DEPTH _ ft <br /> DISTANCE.TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE R Z <br /> ❑ DISPOSAL PONDS WIDTH_ft LENGTH ft DEPTH _ R <br /> DISTANCE 1'0 NEAREST W'F.I.I. ft FOUNDATION ft PROPERTY LINE ft <br /> /p SEEPAGE PITS NUMBER i WIDTH _"�G r� ft DEPTH <br /> DISTANCE TO NEAREST WELL ��Q! R FOUNDATION /ed�� R PROPERTY LINE/ISJ R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTV <br /> ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUIVW NO, ADVANCE NOTICE:REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r <br /> SIGNED `, TITLE S �"_ DATE -�l7�d� <br /> AI <br /> U OLW <br /> LIM <br /> Irk <br /> DEPAR MEN usf ON Y <br /> Application Accepted By Date `"F" rf US Arca _ L•mployce ID# -�-3 <br /> Final Inspectbn B Date Z ElSPECIAL PERMIT-Approved by <br /> Character of Soil to p of 3 Fl: _ Pit/Sump Soil Character: <br /> COMMENTS 0 Ad i-07' of, "C-0.-OA <br /> PE SC Received Amount D to Invoke# Permit ID# <br /> Code INFO B Cath Remitted Se"Ice Request# <br /> 42.ItJ NS moo.o0 200 96 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12,22/203 <br />