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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �a�o <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WLBER AVE-3Y°FI,-STOCKTON CA 93202-(209)46&34J0 <br /> NON-REFUNDABLE PERMIT <br /> JOBADDRESS � � CALL 209 953-7697 FOR I%SPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> � <br /> •� CITY/ZIP <br /> CRO.SSSTREff _ \� ...ST)r.) c APN -��. w y;� <br /> b J O �-Lf PARCEL zE f,. G s <br /> OWNER NAME '�rn_ � ��) ' � o <br /> r r> r� 1K�icLflrs <br /> PHONE <br /> OWNER ADDRESS +0,' <br /> CITY/STATI%LIP <br /> CONTRACTOR <br /> c% ✓ C71� <br /> PHONE <br /> CONTRACTOR ADDRESS Q• t r (/t o r <br /> WATER TABLE DEPTH• <br /> LICENSE ❑C-42 ❑C-36 OTIIEa NUMBER <br /> EXPIRATION DATE <br /> _ H GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST # �— Y <br /> BUILom_ <br /> DING PERMIT# LA D USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION <br /> 13 03 <br /> ❑ ENGINEER DESIGNED <br /> /ALTERNATIVE <br /> ❑�D—EWIRUTC�TIONINSTALLATION WILL SERVE: ❑ RESIDENCE O COMMERCIALOFHERNUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: UMDER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MPG— CAPACITY <br /> (3 GREASE TRAP TYPE/MFGgel #OFCOMPARTMENTS_ CAPACITY <br /> gal #OF COMPARTMENTS_ _ <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION <br /> ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINEs <br /> LENOTtI OF LINES R <br /> DISTANCE.TO NEAREST WELL R FOUNDATION It PROPERTY LINE \ <br /> 13 FILTER BED WIDTH ft <br /> H LENGTH R DEPTH <br /> DISTANCETONEAREST WELLfl <br /> ft FOUNDATION R <br /> 13 MOUNDED LME ft <br /> MOUNDED WIDTH R LENGTH fr DEPTH <br /> DISTANCE TO NEAREST WELLR <br /> R FOUNDATION ft <br /> Ll SUMPS LME R <br /> SUMPS WIDTH ft LENGTH fl <br /> DEPTH <br /> DISTANCE TO NEAREST WELL It <br /> ft <br /> ❑ DISPOSAL PONDS WIDTH ft R FOUNDATION ft PROPERTY LINE <br /> LENGTH R DEPTH <br /> DISTANCE TO NEA REST WELL ft <br /> R FOU?.DATION ft PROPERTY LINE <br /> ❑ SEEPAGE PITS NUMBER_WIDTH R DEP1H <br /> DLSTANCF.YONEAREST WELLft <br /> R 'rOIINDATION Tt PROPERTY LINE fl <br /> 1 HEREBY CERTIFY THAT 1 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 /> SIGNED <br /> MINIMUM id HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE DATE. <br /> —Mgt <br /> J <br /> 1 <br /> N r � <br /> DEP RTMENT US ONL <br /> Final lnspecfM <br /> Application Accept• Date � /� <br /> Area Employee ID#��s i <br /> n By �_ Date <br /> E3 SPECIAL PERMIT- <br /> Chsracter of:u [D Depth of 3 Approved by <br /> PiVSump Soil Character: <br /> COMMENTS %, � S � <br /> frK <br /> PE <br /> Code IPSiw Received Check#/ Amount Dale <br /> Permit/ <br /> B as emitted .S Ic a uest Invoice# Permit IDN <br /> 42-02-001 <br /> 12124.2003 ONSITE WASTEWA'TF,R PERMIT <br />