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ONSITE WAS' /WATER TREATMENT SYST m PERMI�CANNED <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Ave-3X0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 11,YEAR FROM DATE ISSUED <br /> JOB ADDRESS Al 1 CITY/ZIP m <br /> (( n <br /> SAP <br /> CROSS STREET APN 7 O ' ' O PARCEL SIZE r p <br /> OWNER NAME e. Al �s� C K- "v J! �A -/ �` PHONE I� <br /> OWNER ADDRESS (n� 7J 1 , � CITY/STATE/ZIP J���cz o�CA �S� <br /> \ <br /> CONTRACTOR t 0 k— PHONE 3 <br /> CONTRACTOR ADDRESS 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# LL-.vR-ia t�ryE.[] <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/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 ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it C <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft ^ <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LME <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LME fl <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It p� <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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE _ CL A�— DATE 'L Z O It <br /> D <br /> 1 911 <br /> list <br /> 2 <br /> q M N <br /> 1, <br /> -- - DEFAR-TT ENT USE O LY <br /> .Application Accepted B - Date 0 '� Area--- - Employee IU# .5 � �✓79 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Fl: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Checkli/ Amount Date Pe <br /> r <br /> m <br /> ' <br /> U Invoice# Permit ID# <br /> Code INFO B as Remitted Service Re uest# <br /> 1{Z.xz sV CIt3 ucJ 21 Da <br /> 42-02-001 3C.1 2 ZL- G .2( -l.'(,Zti //,,,� ONSITE WASTEWATER PERMIT <br /> 12/2212003 �Z- .� � 1439 - "��"F <br /> ,2Y) - 7_4,4AM- 10./A/ - 1--�41 03{ - /G A15 ..A--,4tJ1 <br />