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11 <br /> TE <br /> SAN JOAQUIN COUNTY E0N(1SI qLWASHEALTH h..ATER TREATMENT SYSTE1�ERMIT <br /> EPENT 304 E WEBER Ave •J"FL-$iOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT <br /> CALL 209 953-7697 FOR INSPECTIONS <br /> JOB ADDRESS ( I <br /> _ EXPIRES 1 YEAR FROM DATE ISSUED <br /> CROSS STREET I/ CIry/ZIP - <br /> m <br /> APN <br /> OWNER NAME. F+ PARCELSIZE - D <br /> - O <br /> PI a <br /> OWNER ADDRESS <br /> 1 CITY/STATE/ZIP <br /> CONTRACTOR r' �' /l -�I ` � � ' ' ` •• <br /> - <br /> PHONE <br /> CONTRACTOR ADDRESS -/\ <br /> CITY/STATE/ZIP 1 <br /> LICENSE ❑C-02 ❑C-36 OTHER <br /> WATER TABLE DEPTH EXPIRATION DATE <br /> PEGEOGRAPHICAL INFORMATION. Coordinates X <br /> RC TEST # .L. f1 BUILDING PERMIT# Y <br /> TYPE OF WORK: ❑ NEW INSTALLATION LAND USE APPLICATION <br /> ❑ REPAIR/ADDITION -- �' <br /> Ll REPLACEMENT <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ DESTRUCTION �• <br /> INSTALLATION WILL SERVE: ❑ ReslDEno: <br /> ❑ COMMERCIAL CI OTHER _ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: .— <br /> NUMBER OF EMPLOYEES: <br /> Ll St:P'llC'TANK 'I'v Pr./M(li <br /> CAPAI'IIY g;J ('OMI'ARTMI-.NIS <br /> ❑ GREASE THAI' rrrl✓MP.. <br /> -- -- —. CAPACI I Y gal #01 COMPARTMENTS <br /> i <br /> PKG TX PLANT DISTANCO TO NY.AREST: WELI, fl FOUNDATION <br /> It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TVPEOF PUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) J <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES -� <br /> R <br /> DISTANCETO NEAREST WELL H FOUNDATION R PROPERTY LINE it <br /> ❑ FILTER BED WIDTH R LENGTH tl DEPTH <br /> it <br /> DISTANCE 7'0 NEAREST WELL R FOUNDATION it PROPERTY LINE R <br /> ❑ MOUNDED WIDTH1' <br /> fl LENGTH it DEPTH It _ <br /> DISTANCE TO NEAREST WELL R FOUNDATION _ R PROPERTY LINE it <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH ft \ <br /> DISTANCE TO NEAREST WELL H FOUNDATION Il PROPERTY LINE it _ !_ <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION U PROPERTY LINE ft <br /> S <br /> 1 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 /> /"1M I�NIMpUM 2\/�HOU�R ADVANCE NOTICE-RF.QUIRk:D FOR INSPECT lON5-PLEASE CALL 1''09j 95}gFg7 ,C r <br /> SIGNED' TITLE eti(p� _ DATE <br /> l't <br /> C. <br /> • r L <br /> N <br /> L <br /> n / A <br /> - - - - R N v ! <br /> T <br /> DEPARTMENT IJPE LY CJ <br /> Application A epi izy 11c.`-[�_ Date C:S Area 'z 1 Employee IDN <br /> Final Inspect Date's%./) `> ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> jCode <br /> E ENX <br /> Amount Date Permit/ Invoice# Permit IDP <br /> Remitted Service Request# <br /> .a 73 or7 l;G4"411 L <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> 12424003 <br />