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-,ONSITE WAS )VATER'i RE'ATMENT SYSTI ,PERMIT �/oo <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DLI'ARTMENT 304 E WEBER AVE -4"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS N345 � 'it l.l~II1Z!� "t�� CrrY/GIP_ C&At ?L% <br /> CROSS STREET �:,C1�hI�'��%►1 i��D�L\ APN v C'�! PARCELSIZE C <br /> z <br /> OWNER NAME /Y% l L'(<%� ��i1 L1G� / no-1 PHONE: i <br /> OWNI•:RA111)RESS <br /> CONTRAC'I'OIt _ L'1,P�c,`---� Tt1t — - -- - -- - PHONE <br /> CON'I'RAC:TOR ADDRESS L - '23,2s F 1'lrl ;L CI'IAISI'ATE/GIP <br /> J� 4 <br /> LICENSE ❑C-42 ❑C-36 01111:R NUMBER EXPIRA'T'ION DATE <br /> WATER TABLE DEPTH: 11 GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 90 PERC TEST(S) Numm::R I.AND UsE AI viA'A'I'ION# ph <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINF.F.R DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF ENIPLOYEF:S: <br /> ❑ SEPTIC YANK h PF./Mr•G C'APACI1) --.. — Fal P uF CuNIPAR I MI N rs <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL tt FOUNDATION 11 PROPERTY LINE Il <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �I <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH <br /> DISTANCE'r0 NEAREST WH I. fl FOUNDATION Il I'ItcATR I Y i INF fl <br /> ❑ MOUNDED WIDTH 11 LENGTH It DEPTH tI \ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE <br /> ❑ SUMPS WIDTH 11 LENGTH ft DEPTH li <br /> DISTANCE TO NEAREST WELL f1 FOUNDATION Il PROPERTY LINE It a <br /> ❑ DISPOSAL PONDS WIDTH 11 LENGTH fl DEPTH II t <br /> DISTANCE'r0 NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH It LENGTH tt DEPTH ft <br /> DISTANCE TO NEAREST WELL f1 FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 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 /> / 1 1�1UM 24 HOUR ADVANCE.NOTICE REQUIRED FOR INSPECTIONS-PLEASE.C'AI.I.(209)953-7697 <br /> SIGNED �`�. / TITLE jtiV'' <br /> IL K <br /> � avorarw <br /> z <br /> avow ovmxuy.� <br /> w € <br /> avOy arx4gaum > > <br /> J avow M01 x�vr p—T/ <br /> cslriC <br /> N I S r 0 z " p v Z ^! <br /> � r d r zd ,p Q N Itt / I <br /> a a M a C' D <br /> mm m <br /> i ry ry m n N = \I(l: M Fr <br /> cm H U1 I .LFr RT Et T <br /> ,OS'9EE ,OS9Ss(s ,06966 ,05966 ,bE'IE5 Q,r,�2131-1107 Ol <br /> ,ZO'bbb <br /> 4Ft <br /> DEPARTMENT E O 'Application A epled BDateC/ Arca y/y Employee IU#Final Inspect n By Date ��� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth it/Sump S ' Character: <br />/COMMENTS l � ' <br /> � � S <br /> PE SC Received Check#/ Amount Permit/ <br /> Dale n 1i #- Per nit <br /> Code INFO B --Call,- Remitted Service Req uesl# <br /> z5 <br /> 42-01-00I rJ�/ _ �L 4k� -�G6NSITE WASTEWATER PERMIT <br /> I212.-02 /��Xli -n 4 4 <br />