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ONSH E WASTEWATER TREATMENT SYSTEM 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 209 953-7197 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS � /. -�/.i' CITY/ZIP <br /> CROSSSTREET _Qfi"���J APN / !V PARCELSIZE/712 D <br /> O <br /> O <br /> OWNER NAME � /J�j'!�/t/� PHONE7 <br /> 60/ 3_ <br /> OWNER ADDRESS _ CITY/STATFJZIP )/� J <br /> CONTRACTOR 1. PHONE ^ '1 <br /> CONTRACTOR ADDRESS �L CITY/STATE/ZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION LIENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT IMIL DESTRUCTION ) <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: Y <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOEES: <br /> SEPTIC TANK TYPE/MFC z— CAPACITY �OO gal #OF COM PARTMENIS-z— <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS _ <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE IT <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 it <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCETO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL H FOUNDATION ft PROPERTY LINE It <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 /> MINNII MUNf 24}JOUR CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED / /_/�/ � L ADV / TITLE DATE <br /> -ILI V,EVI � N <br /> Ep IL <br /> #1 1 <br /> .PARTMENT USE 'LV <br /> .Application Accepte Dale Z Arca Employee ID# %j <br /> �4 <br /> Final Inspection - Dale - ///G ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to hof 3 FU Pit/Sump Soil Character: _ <br /> COMMENTS eX42 LQr CnE_ 942W :cxz <,"Iic- <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 2 L"2003 <br />