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09 <br /> : . ON I�E WASTEWATER TREATMENT SYSTEM PERMIT <br /> QUIN C'QUNTY ENVIRONMENTAL HEALTH-DEP TME_ �M95Aar]L697 <br /> ' :j �� r•� �+r-l-," .'� <br /> _ ;. 600 E MAIN STREET-STOCKTO14 CA 95202-(209)46$-3420 <br /> NO FUNDABLE PERMIT <br /> e.. s.. iL <br /> L(2 " FOR INSPECTIONS ExPIRES I YEAR FjRom DATE ISSUED <br /> f JOB ADDRESS Q CITY/ZIP <br /> CROSS STREET nQ29m, Ad A �d PARCEL SIZE se 7 <br /> F + L 6- f [ SA I"� / <br /> k OWNER NAME <br /> ' _ PHONE <br /> 45 <br /> OWNER ADDRESS CITV/STATE/ZIP <br /> CONTRACTOR } PHONE <br /> CONTRACTOR ADDRESS b CITY/STATE/ZIP ® 2G <br /> { <br /> i LICENSE X C42 ❑ C-36 OTHER NUMBER EXPIRATION DATE J� <br />. 11M <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y J� <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# I� <br />[ TYPE OF WORK: ❑ NEW INSTALLATIONIf REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 14 ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL. ❑ OTHER f <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY i <br /> gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATIO ft PROPERTY LINE k ft <br /> ❑ LIFT STATION $IZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSE➢SYSTEM) <br /> �M <br /> O LEACH LI LE G C MITERS V � oy - OF LIN LENGTH OF LINES <br /> 44ii }j <br /> DIS 'CE TO N ST WELL ft FOUNDATION ft PROPERTY LINE kl ft <br /> FILTER B TH ft LENGTH Z ft DEPTH ft <br /> DI ANCE Tp AREST WELL 10 ft FOUNDA ft PROPERTY LINE t <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4� ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 0 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 41 ft t <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH �� ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE $ <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> ll ft a i <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <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 /> MIN 2 I C O CE REQUIRED FOR I E T�NS-PL��L(209�)953-7697 <br /> TITL DAT <br /> 1 <br /> 01" I I <br /> ell <br /> II <br /> k <br /> t � <br /> M <br /> I <br /> A II <br /> z <br /> � vro UN <br /> DE <br /> pq <br /> M <br /> DE RTMENT U ON Y <br /> Application Accepted ByrA <br /> te Area Employee ID# r rr <br /> Final Inspection By e 0 SPECIAL PERMIT-Approved by 1 <br /> Character of Soil to DepA of 3 Ft: P[/Sump Soil Character: <br /> CO NTSPP <br /> ] <br /> --- <br /> PE SC Received Check# Amount '' Date Permit/ F <br /> Code INFO B as Remitted Service Request# Invoice# Permit ID# + <br /> 42-01 ONSITEWASTETE P IT- <br /> 05/30/2007 ` <br />