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_? <br /> ONSITE ',,,,.STEWATER TREATMENT ,' 3TEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E%VrrER AVE -3"°FL-$TOCKTON CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ,/1� ��� �,.(Sk ��j� CITY/ZIP GjJJ� s Ln <br /> CROSS STREET W�i43 A,C r APN <br /> 2b7 Q(0 <br /> ,A� PARCEL SIZE C <br /> OWNER NAME rYl SflVGK�f.L,r A••� _ l� Ss3�s (.6Y O <br /> �K� PHONE � <br /> OWNER ADDRESS 434 I� �-(j-( •St CITY/STATE/ZIP <br /> CONTRACTOR 1 C(1 <br /> PHONE <br /> CONTRACTOR ADDRESS <br /> CITY/STATE/ZIP <br /> LICENSE L3 C42 L)C-36 OTHERNUMBER <br /> WATER TABLE DEPTH: <br /> EXPIRATION DATE <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> Y <br /> ❑ PERC TEST # BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION U1 REPAIR/ADDITION <br /> REPLACEMENT <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ ❑ 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 <br /> gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE <br /> ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> BLEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES b QI ft <br /> DISTANCE TO NEAREST WELL So' R FOUNDATION /Q I ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH 1 ft DEPTH <br /> fl- <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ([ <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH 0 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R. <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH tt <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE ( <br /> ❑ SEEPAGE PITS NUMBER WD)TH R DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE <br /> I 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 /> MINIMUM 24 HO R ADVANCE NOTICE REQUIRED FOR INSPECTT/II�ONS-PLEASE CALL(209)953-7697 <br /> C- <br /> SIGNED TITLE on 1-f-m-ftv^ <br /> DATE }Z n, <br /> N <br /> E VI0MNI <br /> DEPARTMENT USE ON Y <br /> Application Accepted By Date <br /> Area Employee ID# fJA <br /> Final Inspection By Date d 11 SPECIAL PERMIT- <br /> Character of Soil to 0!3 C Approved by <br /> COM ENTS Pi Sump Soil Character: <br /> PE SC ReceivedCheck#/ / Amount Permit/ <br /> Code INFO B Cash Remitted Date Invoice# <br /> O / Service Re uest# Pel <br /> s a Q <br /> 42-02-001 <br /> 12=003 <br /> ONSITE WASTEI <br />