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' "'�EWATER TREATMENT SY _EM PERMITCA '°� <br /> ONSITE WA _ �U <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 344 E WEBER AVE -3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT 2—�C Q CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> 1CITYIZIP 9:17 " <br /> JOB ADDRESS C �"� v" ` j <br /> CROSS STREET APN PARCEL SIZE C <br /> V 4 ✓ I U '� �^ <br /> PHONE <br /> OWNER NAME :'� y � <br /> r <br /> OWNER ADDRESS r + IJ CITYISTATEIZIP Z..- <br /> CONTRACTOR !J' PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <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# <br /> TYPE OF WORK: ❑ NTW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED 1ALT91kNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL © OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY g F... ARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft R T ft <br /> © LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED STEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS i' #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r�1 <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft ly <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 <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 �T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft f <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft tj PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft &PTH ft _ <br />{ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft R <br /> I 11 <br /> 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 224 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PUkASE CALL(2099))953-7697 I <br /> SIGNED J ca t r` TITLE u-��,. DATE —77• (�1 � y7 <br /> _. _. <br /> VATR ROAII'E0.NA8. <br /> i\ <br /> v <br /> B �7t <br /> 5f im <br /> f <br /> DEPARTMENT USE O LV <br /> Application Accepted By Area Employee ID# <br /> Final Inspection By `�� Date � 'tee? ❑ SPECIAL PERMIT Approved by <br /> Character of Soil to Depth of 3 Ft: 43�? p Soil Character: <br /> COMMENTS <br /> PE SC Received Check#! Amount Date Permit! Invoice# Permit ID# <br /> i Code INFO By Remitted Service Request# <br /> I I <br /> 42-02-001 O� �� � ONSITE WASTEWATER PERMIT <br /> [2/22/2003 Cwt d <br />