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j ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3MO FL-STOCKTON CA 95202 -(209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS IJ-,17� V'j Com_ !IC I i. CITY/ZIP T <br /> JL rn <br /> CROSS STREET ,v1' i X'�I�' v - APN '-%Zrl �, PARCELSIZE )(6H 1'Cr-ES p <br /> OWNERNAME �If'1 t,C',^i�{ LLC. CTmL- PHONE' t( „IxNrlJr4l5 p <br /> 7 1 H <br /> OWNER ADDRESS U '�I ,��, �C„C�I I I.LI CITY/STATE/ZIP LJ�1 C.4` -`� L <br /> { CONTRACTORyy E� PHONE )`J� L I <br /> CONTRACTORADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> f WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> �❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# ti V 11 jS <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ 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 /> I <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL Il FOUNDATION ft PROPERTY LINE ft -IA <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C^ <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft {) <br /> I <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R � <br /> 13DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft ~ <br /> V <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PL�A($E CALL(209)953-7697 <br /> SIGNEDl�I-i/�<� TITLE�I�V If.�1I1 i�l1 f�l �'� DATE !G Y <br /> IJ <br /> I <br /> I ' <br /> iv ,N <br /> JN ,,, <br /> O M N <br /> T N <br /> L 11 .I <br /> - ! <br /> DEPARTMENT U EONLY <br /> Application Accepted By �(—`"-' —"- Date r�—+ G�C� Area EmployeelD# 5��"''-�' 4G <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: 1 <br /> COMMENTS <br /> I <br /> PE SC Received (, Chea Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# .Invoice# Permit ID# <br /> �(L72 <br /> I <br /> >• 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />