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i <br /> i <br /> ONSITE WA, EWATER TREATMENT SYSTEM PIE 11T <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTtFDEPARTMENT 304 E WEBER AVE-3N0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESSPJIF,I R,r,b e' CITY/ZIP <br /> CROSS STREET t''CLt.,'L- APN /`'!� -L'7 PARCEL SIZE •'� p <br /> OWNER NAME M��`r i_ I��7 Cd" c PHONE w I <br /> I <br /> OWNER ADDRESS CITY/STATE/ZIP i <br /> I I <br /> CONTRACTOR C' ( L �( :- V 1 Y•1C. PHONE C�{ �r�' `-!c I <br /> CONTRACTOR ADDRESS Ir%. i. f{'C {I. CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I <br /> �s PERC TEST #---4-- BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ? <br /> ❑ REPLACEMENT ❑ DESTRUCTION i <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER - <br /> NUMBEROFLIVINGUNITS: 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 /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft �I <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft i <br /> � 1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE <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 ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LME ft <br /> ❑ DISPOSAL PONDS WIDTH ft"LENGTH ft DEPTH ft <br /> _ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE fl <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 /> J,^I <br /> MINIM 24.HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-P/LLE�A/S(E ClLL(209)953-7697 1 <br /> SIGNED ,� V��: r � TITLE 71,`117- I f(L IIT !AA7 It 1� DATE <br /> II <br /> I <br /> `<i' <br /> '•I el_, I <br /> f <br /> _ I <br /> P= <br /> I <br /> I, E <br /> APRI n i <br /> 1612005 <br /> r� <br /> 511 Nfl <br /> Ell ATM N <br /> r <br /> r Li' DEPARTMENT VSE ONLY <br /> Application Accepted By >c--/ '^ Date 4/G/C, Area Employee ID# GCr <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC ReceivedCheck#/- Amount Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> az.z <br /> 2, 1­7-111t- /SC <br /> 7)3^> D.� ` L t 5 O"//.T"/ <br /> i <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />