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/�..' ONSITE WASTEWATER TREATMENT SYSTEM PERIMIT <br /> SAN JOAOIIIN COUMry ENViRONMENTAL HEALTH DEPARTMENT 3Pd E WEBER AVE-3"FL-STOCKTON CA 95202-(209)468-3420 ' <br /> NON-REFUNDABLE PERMIT CALL 209 953 697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOS ADDRESS - .rrf -" CITYlZIP S <br /> CROS STREET L �` APN� �J '(v PAHCELSIT.E <br /> z° <br /> OWNER NAME. <br /> OWNER ADDRESS -L.II <br /> CITYISTATEIP <br /> CONTRACTOR <br /> PHONE <br /> CONTRACTOR ADDRESS F"'r CriYlSl'ATE17AP <br /> LICENSE ❑C-42 ❑C-36 0'1"13ER _ NUMBEA r' EXPIRATION SATE I <br /> 1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: t"nprllinBtes JX y <br /> U PERC TEST # IiU1LDING PERMl7�l LAND USE APPLICATION# <br /> TYPE OF WORK: O NEW INSTALLATION ❑ REPAIR/ADDITIOW Lj NGIN-"K DEStCNED 1ALTER:NATIVE r <br /> O RTPLACENIENT DESTRUCTION. <br /> INSTALLATION WILL SERVE: ❑ RFSIDE:'CEI, ❑ COMMERCIAL <br /> L) OTHER <br /> 1 <br /> Num BER OF LIVINC UNITS: ..4NUMBEROF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> Q SEPTICTANK TYPEIMFG �: CAPACITY ' al O P E <br /> ❑ GREASE TRAP TrPEIMFG CAPACITY ' f'E C lI -` ,�PAy"1l .. .� <br /> ❑ PKG TX PLANT DISrANCRToNCA REST: WELL fl FOUNDATIONPEi�mlt MaV have a re fti}hqNj fl <br /> ❑ LIFT STATION SIzE— TYPEOFPuMP W016 be*g og�W� 08E5DEM) <br /> LEACH LIN Q LEACHINGCHAMAERS #OF LIN 9����r�� i;sNaivEp'L.�� ,k1f1�jSloEEnGGII!! N <br /> DISTANCE TO NFAREST WELL ft FOUNDATION ft PROPERTY LINE _ Ij <br /> ❑ FILTF,R BED WIDTH ft LENGTH -.._ A Di Pm It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENOTH ft DEPTH g <br /> DISTANCETO NEAREST WELL ft FOUNDATION fl PROPERTY LINE _ Ft <br /> SUMPS WIDTH _ft LENGTH ft DEPTH I} <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ff PROPERTY LINE fl <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE _ fl <br /> Q SEEPAGE PITS NUMBER WIDTH ft DEPTH fl <br /> DISTANCE:TO NEARFFr WELL ft FOUNDATION fl PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE;PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQIAN COUNTY <br /> ORDINANC N STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQLIN COUNTY. E <br /> MI h U 24 NO ADVANCE NOTICE REQUIRED FOR INSPECTIONS-`PLEASE CALL 009)453-7697 ' <br /> SIGNEQA TITLE `41 OA'I"E <br /> i <br /> Ilk <br /> I <br /> ! i <br /> I <br /> o N�N <br /> R � <br /> I <br /> EPART{MEN[T�U , <br /> p Icallon Ace~a _ Date /1`1 Arra Employee I lhl!� � <br /> incl Inspection By Date f ❑ SPECIAL PERMIT-Approved by <br /> Character pti of Ft: _ PIHSUMPSOH Character: <br /> t.OMMENTS—'4 r ✓f, ��""�'^ a..r� p�gRrY� 41 .�ut�S vf�rt �J1fr , s <br /> PF, I SC Received Che AmnaaT Permit! --- i <br /> Cade INFO B Cash emittl Dale Service Re uest# invoice 4 Permit IDiI <br /> 42-02-ODI ONSITE WASTEWATER PERMIT <br /> luzz2ao� <br />