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SCANWE <br /> ONSITE WA ,EWATER TREATMENT SY( .EM PERMIT v� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WE Rik AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT 2­0 eqCALL 209 953`-77697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS �_ " _Y-^ yv L_ CITYIZIP Z L <br /> ss r <br /> APN CROSS STREET }lvla <br /> a <br /> '.4 r <br /> PARCEL SIZE <br /> z <br /> OWNER NAME. PHONE rn <br /> OWNER ADDRESS „i �(�S �.- t 1� =:��.J1-.s�^E CITVISTATE/ZIPT <br /> CONTRACTOR v PHONE `^7 - Lj <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> f WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />{� PERC TEST # BUILDING PERMIT# T LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ N1W INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTS NATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL THER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: N ` E LOVEES: <br /> ❑ SEPTIC TANK TVPE/MFG CAPACITY gal .u <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COM PAR) NTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) h� <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft 1(x'1' <br /> 4') <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f7Z <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 WIDTH ft DEPTH }} <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 1� <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 ,a TITLE1~�.Q,� �-� - DATE I U <br /> FTM ROUTE NO.BR <br /> K903 1`1�1141 <br /> DEPARTMENT USE O LY <br /> Application Accepted By —`Date._ .lam C?(� Area Employee[D# & <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Date Invoice# Pcrmit[D# <br /> Code INFO By .Remitted Service Request# <br /> 3.7 L_:,LJ 31 v L. I I <br /> ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />