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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3D4 E WEBER AVE-3""FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMj�IT /) CALL(209)953-7697 FOR INSPECTIONS EXPIRES l YEAR FROM <br /> �DATE ISSUED <br /> JOB ADDRESS v 7 fT w If Z z CITYfZIP n <br /> cl El �-CD -1!J CiV V-' <br /> �- / <br /> CROSSSTREET LaL./S�- /K/e APN 05(- /ZU-I Y PARCELSIZE Z-Zt� Q C C <br /> OWNER NAME ,CA�� iELKrNS PHONE <br /> OWNERADDRESS r-O RS U)C 3 ii- // CITVISTATVZIP I/f C-/-Z) ,- a'0 9s'as� <br /> CONTRACTOR <br /> LQ,IZtYl(� q h f PHONE <br /> CONTRACTOR ADDRESS CITVISTATFJZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER O EXPIRATION DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# - D 3O!73 L LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIPJADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> N UMBER OF LIVING UNITS: 1 NUMBEROFBEDROOMS: 3 NVMBEROF EMPLOYEES: r <br /> � <br /> SEPTIC TANK TYPEJNIFG &bele. SL✓e CAPACITY /(900 gal #OF COMPARTMENTS o` <br /> ❑ CREASE TRAP TYPE/MFG. Q CAPACITY, 7 gal #OF COM PARTMLNTS 7^ <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL 80` R FOUNDATION I3 1 ft PROPERTY LINE /"'o ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINESLEACHING CHAMBERS #OF LINES _ LENGTH OF LINES <br /> �y <br /> DISTANCE TO NEAREST WELL l04 ft FOUNDATION ft PROPERTY LINE `'-'V+ ft 00 <br /> ❑ FILTER BED WIDTH ft LENGTH ft 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 R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUM1IPS WIDTHft LENGTH ft DEPTH R <br /> DiSTANCETONEAREST WELL It FOUNDATION 8 PROPERTY LINE it 1 <br /> ❑ DISPOSAL PONDS WIDn[ ft LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTYLINE ft � <br /> SEEPAGE PITS NUMBER WIDTH ft DEPTH ods ft <br /> DISTANCE 70 NEAREST WELL _ ft FOUNDATION Yl0 ft PROPERTY LINE �bO ft <br /> I 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 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2D9)953-7697 <br /> SIGNED TITLE /OH DATE <br /> J C <br /> PQ ` <br /> -- <br /> DEPARTMENT U E NLy <br /> L1 <br /> Application Accepted By Date J `f U5 Area Employee ID# <br /> Final lDspection By oL�!��� �:.� Date .3-'/�nS C3 $PECI PRMI -Approved/b <br /> C <br /> Character of Soil to Depfh of 3 YPit/Sump Soil Character:COMMENTS /1z ✓ /c,i �{ ecu.-�I Pit(79-74 <br /> PE SC Received Check#1 I Amount Date Permit( Invoice# Permit[D# <br /> Code INFO B Cash Remitted Service Request# <br /> IFz.t3 (1-7 �d 3zo-oO 0 Lf I -?wa- <br /> 42-02-001 �' � <br /> It/ZZ/2003 <br />