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ONSITE WA'",EWATER TREATMENT SYS�?M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT4-6ARTMENT 304 E WEBEho.4 -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 /> JOB ADDRESS125105 5 MRMTtle-Y ��, CITY/ZIP <br /> n <br /> CROSSSTREET A p <br /> L <br /> � , AAPN <br /> OWNER NAME RRN <br /> PHONE .u�+ <br /> OWNER ADDRESS CITV/STATFJZIP <br /> CONTRACTOR S&iQ :r =MG 'NONE L4 Wei- <br /> CONTRACTOR ADDRESS ISS _&f0kt J ) ``CITY/STA/�TE/ZIP 'J�LrTQTq <br /> C�31 lS� � <br /> LICENSE IS C-42 ❑C-36 OTHER NUMBER .�/ <br /> _ 15g5j D EXPIRATION DATE 0 'Z� O S <br /> WATER TABLE DEPTH: = ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ <br /> TYPE OF PF WORK:TEST(S) NUMBER - LAND USE APPLICATION# . <br /> 0 NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCEO(�iM ERCIAL Tx ER{,� /2 y, p <br /> NUMBER OF LIVING UNITS: � -,2. pp � NUMBERO BED0.00MS: NUMBERO MPLOYE S:r ^ <br /> SEPTIC TANK TYPE/MFG may/N(„7C.t71 C.+ ��L CAPACITY r(pl�Q gel #OF COMPARTMENTS \i <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal <br /> it <br /> COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL of + ft FOUNDATION IS/i- ft PROPERTY LINE JV/ ft <br /> ❑ LIFT STATION SIZE TYPE OF PU ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES W LEACHING CHAMBERS 3�. ' E #OFLINES LENGTH OF LINES ft �n <br /> DISTANCE TO NEAREST WELL DATION R PROPERTY LINE it <br /> IC FILTER BED WIDTH ZOJ ft LENGTH Lkoj ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 100'+ ft FOUNDATION 10'4 ft PROPERTY LINE 7 C <br /> ❑ MOUNDED WIDTH II LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH it DEPTH R <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 R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH R 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 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 TITLE DATE O(oIO2,103 <br /> Uq IG(,0N IN <br /> BL C <br /> Ht A p ISI <br /> G 7 <br /> 0 <br /> 7 . 2 <br /> s I <br /> S 3 ' <br /> G p <br /> DEPARTM T USE IFJ ee ID# S'v L �, 1j -/�I <br /> Application Accepted By Date �� Area �(! Employee ID#y�_ <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De th of Ft: Pit/Sump Soil Character: <br /> COMMENTS 22, <br /> IZL-Odw—ow <Z05 tze�ae <br /> 1>//�B�/vly ut35 p�i Z - — �J J <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> 6Z 3-3 to 03 5Rao3tiv 31 <br /> 42/2/02 1 <br /> a9 3 S man <br /> 12/2/02 IdB33 ONSITE WASTEWATER PERMIT <br />