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ONSITE WAS i NATER TREATMENT SYST T PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS __!Lo V O 4 . JA'j:f 'C 11 _-_ CITY/ZIP <br /> a <br /> CROSS STREET pC '»Gi APN O t 'l Ry 0 — 171V ARCEL SIZE ?�'� p <br /> v <br /> OWNER NAME - l �R n 1 � cg,.� �hY\G'� .,,...,-..,_. PHONE <br /> 4 y <br /> OWNER ADDRESS // CITYISTATEIZIP <br /> 1 IFCONTRACTOR P PHONE {O 27 A2e <br /> CONTRACTOR ADDRESS 7� CITY/STATE/ZIP <br /> LICENSE: ❑C-42. Q C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TAw,r,DEPTH: It GEOGRAI'IHCAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_0 c50 O 3 Z <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL © OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PU 1 l t ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br />�k ❑ LEACH LINES ❑ LEACHING CHAMBERS #oFUINES LENGTH OF LINES ft <br /> l DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> If ❑ FILTER BED WID-rH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 /> i ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 'FITC • DAT$ . (f? f n C <br /> l v j 1_ <br /> 6 <br /> !� <br /> 4RE <br /> CM <br /> P <br /> o <br /> 0 <br /> t <br /> _J I <br /> i <br /> DEPARTMENT USVONLY <br /> Application Accepted BDate b1f 216C Area Employee ID# S (� <br /> Final Inspection By Date Go ❑ SPECIAL PERMIT,-Approved by <br /> Character of Soil to I))epth of 3-Ft: Pit/S mp oil Character: <br /> C MMENTS <br /> o <br /> PE SC Received Check#/ Amount Date Permit! � <br /> Code INFO B ssh Remitted Service Request# �7P <br /> z z .s ;t4 L G �j•c/1� o oD 5 -�- c- <br /> 42-02-001 X5_1 e /V NE4Y'ASTEWATERPERoMIT <br /> 12/22120031 S/ //c]-� f !/ /-fir? � � � •r�....< >.� <br />