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//3D <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-V FL-STOCHTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PER�MIT�r CALL 209 953-7697 FOR INSpECrrONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS l0 L7 O CITYMP L o- LA-- 6115Z4JQ <br /> CROSS STREET V rr = APN 0 11 '5 A Z�'O > <br /> p �/ PARCEL 312E 1 1 0 <br /> OWNER NAME _ }�b E. PHONE 77 <br /> OWNT.RADDRESS 11 <br /> CITY/STATFJTdP <br /> CONTRACTOR 00 <br /> PHONE ala I <br /> CONTRACTORADDRESS 0 7- n CITY/STATFJZIP Z 4-J <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coardinstes X Y <br /> pERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_r_ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAWADDITION ❑ ENGINEERDF.StQNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DEsrRDCTION <br /> P <br /> NSTZLAT[ON WILL SERVE: L3RrsiDENCI ❑ COMMERCIAL L3 OTHER <br /> NUMBER OF LIVING UNITS:_ -NUMBER OP BEDROOMS: NUMBEA OF EMPLOYEES: <br /> ❑ SEPTIC TANK 7YFFJMFG_ CAPACITY gal #OF COMPARTMENTS <br /> L1 GREASE TRAP TYPPJMFOCAPACITY gal #OF COMPARTMENTS <br /> C3 PKC T%PLANT DISTANCE TO NEAREST: WELL B FOUNDATION _ R PROPERTY LINE f1 O <br /> ❑ LIFT STATION SIZE TYPE OP PUMP_ ❑ SAND OIL SEPARATOR(ENcLosEDSYsrEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #oFLINES__ LFNGTIf OFLINEs n <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ _R <br /> ❑ FILTER BED WIDTHft LENGTH ft DEPTH ft <br /> DISTANCE T'O NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENOTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENOTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPACEPITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME 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(209)953-7697 <br /> SIGNED_ - - .f1.' TITLE- DATE <br /> c <br /> - l <br /> i `l <br /> 9P <br /> N 0aIN <br /> E T <br /> �I F DEPARTMENT USE ONLY <br /> Apff�.I..,Acc. B - G- -- to_ O' O�' /t Area Employes IDI! <br /> Final Inspection Bytre" tc `" L ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept 13 Ft: PitISUmp Soil Characters <br /> COMMENTS Y <br /> PE SC Recelved Check#/ Amount PcrmiU <br /> :bdC INFO B Remilled Date lavolet# PermitlDk <br /> Fm to s z <br /> 42.02-001 <br /> 12/22/2003 ONSITE.WASTEWATER PERMIT <br />