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ONSITE WA WATER TIS,ATMENT SYS iM PERMIT / <br /> 5AN J QUIN COUNTY ENVIRONMENTAL HEALTk�. -PARTMENT 304 E WEBER.,,,.: -3"°FL-STOCKTON CA 9$202 - (209)468-3420, <br /> N REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS E PIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 100 E • r ITY/ZIP L <br /> CROSS STREET APN �/5- /30 ��/ PARCEL SIZE 0�� 4-c-- O <br /> o P <br /> 7 <br /> OWNER NAME G+ PHONE y� RR VV y <br /> OWNER ADDRESS 7 CITYISTATE/ZIP �+ <br /> CONTRACTOR c 1+ PHONE <br /> CONTRACTOR ADDRESS 7 CITY/STATEIZIP - _ - ;iw o <br /> LICENSE C-42 L3 C-36 OTHER NUMBER j5 T. EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> © PERC TEST # BUILDING PERMIT## - LAND USE APPLICATION## . <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> R" <br /> k SEPTIC TANK TYPE/MFG CAPACITY gal #.OF COMPARTMENTS <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 T0? LENGTH OF LINES 0 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION !�jt 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 LINE ft <br /> SUMPS C,3 WIDTH C ft LENGTH - 1.0::� ) ft DEPTH /0 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 FOUNDATION ft PROPERTY LINE ft <br /> r <br /> ❑ SEEPAGE PITS NUMBER WIDTH c`�r� l <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> I 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 24 HOUR ADVAN E NOTICE REQUIRED FOR INSPEC 11DNS-PLEASE CALL(209)953-7697 <br /> C r/ <br /> SIGNED ��C TITLE DATE <br /> E <br /> ALL 4 <br /> d <br /> L� <br /> L <br /> Y <br /> FF - - _ - - - <br /> E <br /> DEPARTMENT USF ONLY ENVIRONMENTAL 4 <br /> Application Accepted By cam-- Date [V us Area HEALTH DEPAR Wee ID# Col✓? <br /> Final Inspection By Date © SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft) Pittsmp Soil Character err x <br /> COMMENTS &6_c,_) r— o- IE�L 3--2_f, E-J GS lOt Sri--e,,_5 <br /> 1l­��3 6 E 1,50 FT_ 14-uj <br /> VMVE' <br /> nt Permit/ <br /> ed Date ServiceRe uest# L� � 19 0� (�C) <br /> 42-02-001 7���d! [` (:-9 <br /> -� � <br /> 1212712003 ��L s; � <br />