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ONSITE WAS, +I�VATER TREATMENT SYSTfj PERMIT <br /> SALT JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AV}; -3"'Fl;-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNAABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBAnnREss <br /> �GC{ - - CITYIZIP �d 0lk—& <br /> y <br /> CROSS STREETGJ7 G - I e n <br /> .APN C)6ADT PnRCELSIY£ L d <br /> OWNER NAME �f//�/rj ///LC1�W1 �✓� 'T— 'PIIONE --;533 <br /> OWNER ADDRESS CITYISTATEIZIP 7CONTRACTOR �. G (.GL '" C' G PIION' E � -C���� <br /> I <br /> CONTRACTOR ADDRESS '7G(1?:� ?�t �1 �/IJ�G.. CITY/S-TATE/ZIP �:Gt. <br /> LICENSE bIC-42 ❑C-36 OTHER NUMBER EXPIRATION DATE l/` <br /> WATER TABLE DEPTH: :.ft GEOGRAPHICALINFORMATION: Coordinates X Y - <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICA"LION# VTf <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION I C1. ENGINEER DESIGNED/ALTERNATIVE <br /> L] REPLACEMENT ❑ DESTRUCTION <br /> f INSTALLATION WILL SERVE: RRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LiviNG UNITS: NUMBER OE.,BEDROOMS: NUMBER OP EMPLOI'EF,S: ee) <br /> ❑ SEPTIC TANK TYPE/MFG �jy ��',tJwj CAPACETY /6�_ gal ,#OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENT:S <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION Il PROPERTY LINTS it <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) . <br /> I <br /> LEACH LINES ❑ LEACHING CHAMBERS #of LINES <br /> . HA � LENG7Ei OF LINES <br /> DISTANCE TO NEAREST WELL X) A FOUNDATION 11 PROPERTY LINE�� + T 11 <br /> 1713 <br /> O FILTER BED WIDTH 1t L1:NGTH f1 DEPTH ft <br /> DISTANCE TO NEAREST WELL 11 FOUNDATION - 11 PROPERTY LINE R <br /> ❑ MOUNDED WIDTH 11 LENGTH 11 DEPTH f1 <br /> DISTANCE TD NEAREST WELL ft FOUNDATION El PROPERTY LINE f1 <br /> ❑ SUMPS WIOTII fl LENGTH 11 DEPTH ft <br /> DISTANCE TO NEAREST' WELL ft -'FOUNDATION f1 .PROPERTYLINE ft <br /> ❑ DISPOSAL PONDS WIDTH t1 LENGTH 11 DEPTH_ It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION f1 .PROPERTY LINE Ft <br /> SEEPAGE PITS WIDTH �r R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL 11 FOUNDATION (J It PROPERTY LINE i/y, ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STAT'EI,LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI 'IMUIII 24 HOUR ADVANCE NOI-ICE REQUIRED FOR INSPEC_I—'IOONNSJ PLEASE CALL(2.09)953-7697 <br /> SIGNED TITLE_lr�! G`- -- DATE lr3 <br /> rh <br /> Lj <br /> I. <br /> r <br /> RECEIVErb <br /> AL <br /> My <br /> 4, <br /> Ir <br /> (JAQUlt I C UN Ty <br /> I EIJ <br /> VIR N ENT l H AIT <br />{ <br /> T <br />