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ONSITE WASWATER TREATMENT SYST'-"-NI PERMIT lour /v <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH IF$rARTMENT 304 E WEBER..-Ty 3"°FL-STOCKTON CA 95201 - (209)468-3420 <br /> NON-REFUNDABLE <br /> � PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS f h Ca m I W R,oaaCITY/ZIP <br /> 96,360 <br /> CROSS STREET CJS k� i�� APN ✓��/^, !yam f ��-' � �:�� a <br /> y 2.-.J"-6�0 6(0, L 1()PARCELSIZE o <br /> OWNER NAME ` - C <br /> PHONE <br /> OWNERADDRESS M-5 Ruth rive CITY/STATE/ZIP i Miq <br /> y � <br /> CONTRACTOR Neil 0. 7 PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 0 C-42 ❑C-36 OTHER NUMBER 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 ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE -t <br /> ❑ REPLACEMENT ❑ DESTRUCTION <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 /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft } <br /> 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 /> UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEEC�TIIOONSy-PLEASE CALL(209)953-7697 <br /> SIGNE TITLEDrDATE <br /> © i <br /> AE <br /> nil <br /> O <br /> 4 <br /> t <br /> PA <br /> C � <br /> - --.�.DEPART,'14C�-NT--US <br /> Application Accepted By Date Ct (3S Area `Employee lD# Lz <br /> Final Inspection By ate i[SC ❑ SPECIAL PERMIT-Approved by !! <br /> Character of Soil to Depth o Ft: Pit/Sump Soil Character: <br /> COMMENTS1�7� MA V � <br /> PE SC Received Check#! Amount Permit/ <br /> Code INFO B as Remitted Date Service Re uest# Invoice# Permit ID# <br /> Lfa-Z--L 5-2- / 7�/•0J 3 I1 o.Sp—ca y <br /> 42.02-001 ONSITE WASTEWATER PERMIT <br /> 1 212 212 003 <br />