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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3YO FL-STOCKTON CA 95202-(209)466-3420 <br /> N-REFUNDABLE PERMIT CALL 209, 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> ADDRESS llrirf`';IfY�a ,'.t 1 � cm/zlr <br /> t{ �+ v'�� PARCEL SIZE <br /> CROSS STREET j" ���G�n 1. -'- APN 1.'',. 1 _ o <br /> c A <br /> iERNAME It,IG `�� '''-�`���- e + PHONE + <br /> /q� Jl I / <br /> `IER ADDRESS \t �1 C 1 ! r'1 h N"C, �L'YI -+ �� Ci� CRY/$TATE/ZIP ! :� <br /> CONTRACTOR Y PHONE <br /> T"CTORADDRESS ` r � 1 Lv CITV/STATE/ZIP,� -! i <br /> -NSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WCI'ER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> '0. PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# - <br /> "-E OF-}VORK: LI NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 1 L ❑ REPLACEMENT O DESTRUCTION <br /> TALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNIT'S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINEboo <br /> R <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP (3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) 71 <br /> LEACH LINES ❑ LEACHING CHAMBERS III OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> BI• FILTER BED WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE It cT <br /> J <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> SUMPS WIDTH ft LENGTH ft DEPTH R <br /> *00 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R <br /> SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCETO 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 <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL I209)953.7697 / + <br /> ;HED / TITLE - — '^,—�..�� DATE I \�: <br /> I <br /> j <br /> j `\ <br /> ( <br /> r !' <br /> R N E <br /> H <br /> DEPARTMENT USFiONLN <br /> Anplication Accepted By 4 /l Area Employer:ID# <br /> gal Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> aracter of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> "MMMENTS <br /> PE SC Rettived ChecWt/, Amount Perm1U <br /> 'ade Inro B '—Cash Remitted Datt Service R unt# Invoice If Permit ID# <br /> Z. <br /> 02-001 ONSITE WASTEWATER PERMIT <br /> 2212003 <br /> Ir <br />