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ONSITE WASWATER TREATMENT SYS 'M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH:.. .ARTMENT 304 E WEBER A EV -3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT /� / CALL(209)953-7097 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS �rrv[i i le'rl?64�/lxe" CITYIZIP Lnc ko krd g5a37 <br /> > <br /> CROSS STREET '/�LrJ�i APN t/ —y�SC�r® I PARCEL SIZE �C� �w �V <br /> OWNER NAME. C �,r (y�s/� J` r <br /> PHONE �G�e��rQk`J �ry'6��3C/�''� ry <br /> OWNER ADDRESS 3.6 J EtsSLJ11 CiCt] W y CITYISTATE/ZIP <br /> CONTRACTOR Zd- L /T/�7�L 7 _ PHONE <br /> � <br /> CONTRACTOR ADDRESS 7-� A GlJ we. CITYISTATEIZIP 6r � <br /> LICENSE UZ-42 ❑C-36 . OTHER NUMBER .EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# " <br /> TYPE OF WORK: ❑ NEW INSTALLATION OL,REPAIRIADDITION ❑ ENGINEER DESK;NEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: U RESIDENCE ❑ COMMERCIAL L1 OTHER <br /> �.r <br /> NUMBER OF LIVING UNITS: f NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: C1 <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ LLFf STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13- LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL �J r ft FOUNDATION 5bft PROPERTY LINE-_ A0 ' ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 4- SEEPAGE PITS WIDTH r ft LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL 15-0 ]f' ft FOUNDATION S'0 ft PROPERTY LINE P ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED E ��sa/J1' DATE <br /> i <br /> r � <br /> J <br /> r3. <br /> e <br /> ch0 <br /> SiA UI C UN <br /> DEPARTMENT USE ONLY <br /> Application Accepted y patent Area Employee ID# 7 �i <br /> Final Inspection ��� Date"Y �Q3 ❑ SPECIAL PERMIT-Approved by ' <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character <br /> COMMENTS 7 /� <br /> � G'�:,o�oxt �/i�,k����,�• �=�c�� /�s� � `?rte <br /> i <br /> PE SC Received Check#! Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BY ash Remitted Service Request# <br /> 42.01.001 <br /> 1212!02 ONSITE WASTEWATER PERMIT <br />