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(0 (". 2- <br /> ONSITE <br /> ONSITE WASxEWATER TREATMENT SYS ,M PERMIT <br /> SAN JOAQUIN CQUNTY ENVIRONMENTAL HEALTF. �ART304 E WEBEk- £ -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CAMENT ZO9)953-7697 FOR INSPECTIONS EXPIR S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITYIZIP <br /> H <br /> tl'1 <br />{ <br /> CROSSSTREET <br /> PARCEL SIZE <br /> iPHONE 2e) 1 <br /> OWNER NAME <br /> —T.. N <br /> j OWNER ADDRESS 6,33c? lx/ ` � a. r P CITYISTATEIZIP 111 <br /> CONTRACTOR * J <br /> PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: GEOGRAPHICAL INFORMATION.' Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGI iEFR DESIGNEp 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 f} PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ .SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES v <br /> DISTANCE TO NEAREST WELL, ft FOUNDATION ft PROPERTY UNE t} <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH i ft LENGTH ft DEPTH f} <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH f} <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L1NE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ f} <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 /> 41 N MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 i <br /> SIGNED 1 <br /> T1TI EDATE 0 <br /> 17 <br /> �--G <br /> ;z W z <br /> I !1J <br /> W <br /> o <br /> CL Lr 2 <br /> �n <br /> Lw <br /> 1 <br /> DEPARTMENT <br /> SE O LY - ��— <br /> Application Accep*Deb <br /> to (.L� Area Employee iD# <br /> Fina]Inspection B Date / © P •. <br /> S ECTAL PERMIT-Approved by <br /> Character at Soil tFt,: Pit/Sump Soil Character: <br /> COMMENTS L.5- i <br /> L�r7 d 4r l <br /> _ 8 <br /> PE SC Received _ffkecW Amount Date Permit/ Invoice# Permit[D# <br /> Code INFO B Cash Remitted Service Re uest# <br /> (97 <br /> i <br /> 42-01-001 <br /> 12/2!02 ONSITE WASTEWATER PERMIT <br />