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go <br /> ONSITE WAS;I,,vVATER TREATMENT SYST' -1[ PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER A*BBi3°°Fl,-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS I��1 ILLI 5 �� CITY/ZIP Srec- =1 <br /> 2 �{�,..� p �n n <br /> CROSS STREET APN /�7 ' �`""wo PARC/EL SIZE `�� I� <br /> OWNERNAME �VIS 9A&-7-45 PHONE t0 rd 3�-,r��+ Vgb <br /> 16 S s `&(LA-I S e,A, -� CITY/STATE/ZIP 7TJ 0e'�NN /C4 , <br /> OWNER ADDRESS �IL�� <br /> CONTRACTOR },/ "Wrj C AA V IL,17 1 PHONE GG <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-02 ❑C-36 OTHER NUMBER EKPIRATION DATE <br /> WAT ABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# <br /> LAND USE APPLICATION <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER- <br /> NU BER <br /> THERNUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 XM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE u .V DATE <br /> M 3 Q <br /> W <br /> Ai <br /> Otto <br /> 3 <br /> JOAC OI <br /> E R Mi Tit <br /> 5 DEP R MENT U q LY <br /> Application Aceepted By - Date - _J 10 - Area - - - _- Employee ID# <br /> - 37 L <br /> Final inspection By CY Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump II Character: <br /> COMMENTS -w — L12 — 25I-1 <br /> I;A,�1 .ACGS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> Lfazz s ! 0 7 a LS <br /> 42.03'001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />