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WNED <br /> ONSITE WAEWATER TREATMENT SYEPE <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH.iEPARTMENT 304 E WEBEh.,VE -3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209),953-7697 FOR IN PE TIONS EXPIREEStr1 EAR FROM DATE ISSUED <br /> JOB ADDRESS �� <br /> CITYIZIP A y 1?5�P 7 � <br /> CROSS STREET APN r)2-">` ' O vPgARCF L SIZE ow 4-lla <br /> OWNER NAME j /� PHHOONNE <br /> OWNER ADDRESS CITYISTATE/Zli -, - <br /> E CONTRACTOR J+ �� PHONE 7� <br /> CITY/STAT tONTRACTOR ADDRESS C <br /> f� <br /> LICENSE -42 ❑C-36 OTHER NUMBER EXPIRATION DATE 1Z <br /> WATER TABLE DEPTH:- � ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT - - ❑ .DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER j <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROF EMPLOYEES: <br /> TYPE/MFG <br /> CAPACITY al #OF COMPARTMENTS <br /> ❑ SEPTIC TANK g <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gaiPPRPERTY <br /> �EP�y - 1 ` <br /> LlPKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R iA ft <br /> ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS / ft <br /> H/ I�`�___ #OF LINES LENGTH.OF LINES <br /> DISTANCE TO NEAREST WELL yrc-f�Q ft FOUNDATION ft PROPERTY LINE �O ft <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 ft FOUNDATION ft PROPERTY LINE 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 42. WIDTH _'5 ft DEPTH ;zS ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> 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 /> M IMUM 24 H UR ADVANCE NOTICE REQUIRED FOR INSPECT NS-PLEASE CALL(209)953-7697 r� <br /> SIGNED � .r /� G —574?42 C-TITLES Y•-��-� DATE <br /> r <br /> al L <br /> -laoO <br /> 1 <br /> N E A <br /> Fi L H E <br /> '- <br /> ! Application Accepted B Date Area Employee ID# <br /> Final Inspection Date /C% '� ❑ SPECIAL PERMI Approved by 'f <br /> Character of Soil to epth of Ft: Pit/Sump Soil Character: <br /> M NTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> rot, Eo s,3 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />