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ONSITE WA �WAT.ER TREATMENT SYSM PERMIT <br /> �� <br /> SAN <br /> N JOAQUIN COUNTY ENVIRONMENTAL HEALTH 'PARTMENT 304 E WEBER A'a£ -3 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM I <br /> DATE ISSUED y <br /> Q, f s� _ CITYIZ1P "3 <br /> JOBADDRESS 1+�+ a Q > <br /> �27L <br /> APN �Cj :� PARCELSIZE /� <br /> CROSS STREET _ L� A <br /> PHONE1 i�G ©C7 _ n <br /> OWNER NAME 1` <br /> CITY/STATEIZIP �. '� `^•r <br /> OWNER ADDRESS <br /> Q PHONE <br /> CONTRACTOR <br /> CITY/STATEIZI P <br /> CONTRACTOR ADDRESS <br /> LICENSE C3C-42 ❑C-36 OTHER <br /> NUMBER EXPI ON A <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X a <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# rs I a <br /> ❑' R1 PAIR/ADDITiON ❑ ENGINEER DESIGNED IALTE IVE <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ DESTRUCTION <br /> f ❑ REPLACEMENT <br /> ❑ COMMERCIAL ❑ OTHER <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE _ <br /> NUMBER OFLIVING UNITS: - <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG <br /> CAPACITY gal #OF COMPARTMENTS <br /> CAPACITY gal #OF COMPARTMENTS r _ <br /> © CREASE TRAP TYPEIMFG <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL f <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ElLEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 8 <br /> ft <br /> ❑ FILTER BED WIDTH ft LENGTH DEPTH ft <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> R LENGTH ft DEPTH ft <br /> ❑ MOUNDED WIDTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <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 fi[ <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> I R <br /> I 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 - <br /> SIGNED t� ESS_, _ DATE ��- <br /> • <br /> ` 7 16.13, <br /> SZ=j �1 3 <br /> 3 G7 <br /> 71 <br /> R <br /> i - <br /> .i A Ul <br /> TmJNF?I-- TA- <br /> :n <br /> M <br /> �Y ea <br /> S .2 S, 0 <br /> a <br /> I <br /> F <br /> w <br /> .-.- AreaEmployee lD# <br /> Application Accepted Date <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep .of 3 t: Pit/Sump iI Character: <br /> COMMENTS 3 b .� ' �✓ <br /> i <br /> PE Sc. Received heck#1 Amount Date Permit/ Invoice# Permit ID# <br /> g <br /> Code INFO By <br /> as Remitted Service Re uest# <br /> ONSITE WASTEWATER PERMIT <br /> 42-02.001 <br /> 12/22/2003, <br />