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ONSITE WAr 'EWATER TREATMENT SYS" ?M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTIft-CPARTMENT 304 E WEBENNeE -3"'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS jEXPIRES 1 YEAR <br /> /FROM DATE ISSUED <br /> JOB ADDRESS �3e �� ��? �(\�/ CITY/ZIP �7pC�l G 7 52C�� <br /> CROSS STREET I.LJI Q L.�6-V/1 APN n 2 I!ZI-09 _Ct 7 a c!Cn <br /> 1 PARCEL SIZE � <br /> OWNER NAME S�1 L. �2(:�1-2.6 r AJC) PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTORAL►1�_1 PHONe �j <br /> CONTRACTORADDRESS��ZS— E 1�1�/f'il►t! �'� CITY/STATE/ZIP S+et.k--tyj "152DS <br /> r <br /> LICENSE ❑C-42 ❑C-36 OTHER G57 NUMBER 4L 7Z55Z. EXPIRATION DATE I 0 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST(S) NUMBER I LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCFION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <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) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE tt <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft UJ <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH tt O <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 WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> r7z <br /> HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-tPLEASE CALL(209)953-7697 <br /> SIGNED TITLE c>I 1 J1L.l�l��t� DATE d <br /> t `l1 I <br /> 301 \A <br /> Vacant +� ri1 PQ <br /> SpA JO 0, M <br /> S� <br /> /5z <br /> PROVE <br /> sir e,, 00 ' � <br /> 10 sr412* <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date DU Area �- Employee ID# �7IL(_ <br /> Final InspectionDate ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth o'f 3,Ft-:. / Pit/Sump Soil Character: <br /> COMMENTS ��� <br /> PE SC Received Check Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BY Cash Remitted Service Rc uest# <br /> 42- 2 7-z, T 9 tp� o S 3 3 <br /> ONSITE WASTEWATER PERK?I"r <br /> 42-01-001 <br /> 12/2/02 <br />