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SAJ <br />HE <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />x RESIDENCE COMMERCIAL OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL _ <br />❑ LIFTSTATION SIZE TYPE OF PUMP <br />CAPACITY t1 p QG 981 # OF COMPARTMENTS_ <br />CAPACITY (JB1 # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINA ft <br />❑ PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS # OF LINES -;k LENGTH OF LINES ��]/� \� It <br />DISTANCE TO NEAREST VVFLL i DO ft FOUNDATION_ft PROPERTY LINE 1`1 <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH tt <br />DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl <br />SUMPS c Z) WIDTH a ft LENGTH a. U It DEPTH h It <br />DISTANCE TO NEAREST WELL t FOUNDATION ft PROPERTY LINES H <br />❑ DISPOSAL PONDS WIDTH ft LENGTH __ I _ft DEPTH ft <br />DISTANCE TO NEAREST WELL I FO NDATION fl PROPERTY LINE ft <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH fl <br />DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE L. WS AND RUL, AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />N�tM+I�( n <br />SIGNED Y 1U HO R� E/ R FO TLE PEC I -�EA CALL 09)951-7E37 <br />J� DATE 1 <br />PE SC Received Check#I Amount Date PO'm Invoice # Permit ID# <br />Code INFO By Cash Remitted Service RecLuest# <br />42-01 <br />1014'07 <br />�BT,-S <br />7 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERM.T <br />-p"- <br />ONSITE WASTEWATER TREATMENT SYSTEM <br />PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON <br />CA 95205.6232 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-76997 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUE[ <br />JOB ADDRESS 5 ( C. CITYIZI/P5 <br />1 -1t� cl <br />^ '- <br />/ <br />CROSS STREET I J 1 " 0 1 APN /N� � ham+, - 0 v <br />PCEL 12E <br />AR <br />L -r <br />-Nt <br />I <br />F,Orui � <br />OWNER NAME <br />OWNERADDRESS{^��L�J/V CITSTE/ZIP <br />PHONE <br />C-��/(��rQ(_ <br />CONTRACTOR \ 1'l�� ` 1l/T� Cm- <br />r�T% <br />j' <br />CONTRACTOR ADDRESS COC O �,� I\ J �\ I�yj Jl \lT V J� C CITYISTATFJZIP \ ` <br />IL l J -7 1� <br />LICENSE , C42 - C-36 OTHER NUMBER I `:� EXPIRATION DATE <br />WATFR TABLE DEPTH: %tJ LJ t GEOGRAPHICAL INFORMATION: COOfdin s X <br />Y <br />PERC TEST # BUILDING PERMIT # AND USE APPLICATION # <br />TYPE OF WORK: 7, NEW INSTALLATION REPAIR/ADDITION <br />ENGINEER DESIGNED IALTERNATNE <br />REPLACEMENT DESTRUCTION <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />x RESIDENCE COMMERCIAL OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL _ <br />❑ LIFTSTATION SIZE TYPE OF PUMP <br />CAPACITY t1 p QG 981 # OF COMPARTMENTS_ <br />CAPACITY (JB1 # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINA ft <br />❑ PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS # OF LINES -;k LENGTH OF LINES ��]/� \� It <br />DISTANCE TO NEAREST VVFLL i DO ft FOUNDATION_ft PROPERTY LINE 1`1 <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH tt <br />DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl <br />SUMPS c Z) WIDTH a ft LENGTH a. U It DEPTH h It <br />DISTANCE TO NEAREST WELL t FOUNDATION ft PROPERTY LINES H <br />❑ DISPOSAL PONDS WIDTH ft LENGTH __ I _ft DEPTH ft <br />DISTANCE TO NEAREST WELL I FO NDATION fl PROPERTY LINE ft <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH fl <br />DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE L. WS AND RUL, AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />N�tM+I�( n <br />SIGNED Y 1U HO R� E/ R FO TLE PEC I -�EA CALL 09)951-7E37 <br />J� DATE 1 <br />PE SC Received Check#I Amount Date PO'm Invoice # Permit ID# <br />Code INFO By Cash Remitted Service RecLuest# <br />42-01 <br />1014'07 <br />�BT,-S <br />7 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERM.T <br />