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C/v <br /> ONSITE WAS;, NATER TREATMENT SYS I I PERMIT <br /> 304 E WEBER AV-70-3""FL-STC' i'TON CA 95202 - (209)468-3420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT fi CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR <br /> XPIRES1YEAR FROM DATE ISSUED <br /> CITY/ZIP /tJY� <br /> JOB ADDRESS <br /> CIOSS STREET ! il/ /� � • APN' �w.,� ��`� `' PARCEL SIZE d O <br /> �* <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR Iy C PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE W-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C3PERC TEST # BUILDING PERMIT# AND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE _COMMERCIAL LJ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF B DROOMS: NUMBER OF EMPLOYEES: \\ <br /> /J u�.a � <br /> SEPTIC TANK TYPE/MFG lci� / _ CAPACITY �+- gal #OF COMPARTMENTS a <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #of LINES 3 LENGTH OF LINES Q ft <br /> DISTANCE TO NEAREST WELL J�"Lf , ft FOUNDATION 46-; , ft PROPERTY LINE 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 LME ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ ft- <br /> DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �C SEEPAGE PITS NUMBER 3 WIDTH C ft DEPTHyS <br /> DISTANCE TO NEAREST WELL ft FOUNDATION /Q ft PROPERTY LINE Q'CY ft \ <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. ✓ - � TITLE�� �� t� �y�- DATE <br /> �i <br /> o O <br /> J� <br /> A UI p <br /> TA <br /> DEPARTMENT <br /> Application Accepte Date Area Employee ID#�� [ <br /> Final Inspectio By Dat ❑ SPECIAL PERM"IT Approved by <br /> Character of Soil to Depth of 3 Ft: ,.,�\ Pit/Sump Soil Character: rrXl <br /> COMMENTS OLD C,67- e97-':bT" g " C5 <br /> P P4 6 � !t; 4 'Sr�r 'Awla GY" 6r <br /> Vf fey i L w ]R T- AVA9C ro 1�Ylf.�S/ ,�}ttp,.Ln`.ytn Ia-L(, RM <br /> PE Sc Received Che / Amount Permit/ <br /> Date C�voice# l Pe�.Irtit ID# <br /> Code INFO BV Cas Remitted Service Request# / U/ �T <br /> 00 Roo 4 <br /> rex 2� e� <br /> 42-02-001 � ' .�� l�j �j�jr/^ 1 r> /� ` ���TEWATEI'r`PERMIT <br /> 12/22/2003 <br />