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ONSITE WASTEWATER TREATMENT SYSTEMPEItAIIT - <br />SAN JOAQUIN COUNTY ENYTRONMENTAL HEALTH DEPARTMENT ' <br />i600 E MAIN STREET - STOCfcrON CA 95202 - (209) 468-3420 NON-REFUNDABLE PERMIyT C �I L�2w09 953-7697 FOR INSPECTIONS <br />JOB ADDRESS EXPIRES I YEAR FROM DATE ISSUED <br />I / p� rJ ' /✓ CL�r r j�l/�• ` _ r <br />CITY/ZIP <br />i CROSS STREET L-A) ' <br />APN IJ S3 - A06 —0 c� PARCEL SIZE UY <br />OWNERNAME —S T E✓E,�J t <br />j 8 2 Er'7aCni.sc(LIi.. �'� . I o <br />PHONE <br />• OWNER ADDRESS . t_ r.!• • i r ; h •. tc. 1 ' <br />CrrY/STA"rE/ZIP , ' .• . ` <br />CONTRACTOR '�y' / r ` I / G E- , <br />PHONE <br />22 7 <br />CONTRACTOR ADDRESS - CITY/STATE/ZIP . <br />LICENSE ,� C42 ❑ C-36 OTHER NUMBER y'��f%{� ' ' <br />7 EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />❑ . PERC TEST , # Y <br />BUILDING PERMIT,# ,_.. r... LAND.USi'{ APPLICATION # <br />TYPE OF WORK: O I NEW INsTALLAnoN REPAIR/ADDrITox <br />.O' ENGINEER DESIGNED /ALTERNATIVE I <br />REPLACEMENT ' ... ... DESTRUCTION <br />❑ <br />INSTALLATION WILLSERVE:' RESIDENCE '•� rh l I <br />❑ COMMERCIAL. ' ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: D • , [)3 <br />,NUMBER OF EMPLOYEES: ' <br />❑ '" SEPTIC TANK TYPE/MFG C ^ 'L CAPACITY ' <br />❑ 'GREASE 8 # of Cor nRTMENTs C <br />. . -TRAP �TYPEMIFG CAPACITY gal` #OF COMPARTMENTS <br />" 11 • DISTANCE TO NEAREST:_ WELL. • : it" <br />,- • FOUNDATION ft , • PROPERTY LINE " , <br />Ll LjPTSTATION SIZEPUMPL. ft <br />TYPE OF ' <br />13.. <br />Pka TX PLANT L] SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES ' O LEACHING CHAMBERS r <br />' . #OFLfNES LENGTH •OF LDIES <br />' DISTANCE TO NEAREST J WELL % •. •� I ft ' I • FOUNDATION R IPROPFRTY LINE <br />O FH,TERBED WIDTH <br />ft LENGTH ft <br />DEPTH ft. <br />DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE <br />O MOUNDED WIDTg ft <br />R LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST _WELLR FOUNDATION R PROPERTY LINE <br />0 SUMPS WIDTH - ft LENGTH ft <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />'13 DISPOSAL PONDS WIDTH ft <br />R LENGTH ft <br />ft DEPTH <br />'' DISTANCE TO NEAREST WELL' r it "`ft FOUNDATION"`"PROPFRTYIJNE <br />O ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ' <br />DISTANCE TO NEAREST WELL R •. R <br />.. - ft FOUNDATION ft PROPERTY LINE <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. COUNTY <br />SIGNED <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL'(209) 953-7697 T ` <br />�' , TITLE G,�� DATE <br />42-01 <br />05/10/2007 <br />ll07y 1 'Area 4 , Employee ID# .r3 40 <br />. <br />0 SPECLAL PERMIT - Approvbd by <br />Pit/Sump Soil Character: , <br />ONSITE WASTEWATER PERMIT <br />J <br />1 <br />�1 <br />Z <br />r/ <br />