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130 /o/ <br /> ONSITE WASTE" -ATER TREATMENT SYSTEP `PERMIT <br /> SAN 30AOIIIN COUNTY ENVIRONMENTAL HEALTH DEPA`/RIENT 304 E WEBER AVE 41ad FL-STOCKTON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS t o 9.1m- /y L(.-5- LFJ IyP CITY/ZIP m <br /> p a <br /> CROSS STREET L� _S.?� I APN f,SR� l(()— PARCELSIZE <br /> OWNER NAME =N DF �\ rj)P_fv " 4Y M re I7- PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR / L1�T�c��1/[/-- PHONE <br /> CONTRACTOR ADDRESS /'•�� /Il/R f%✓YV�. CITV/STATE/ZIP <br /> LICENSE 0,CA2 ❑C-36 OTHER NUMBER 6 � S_ EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X V <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT *gkDESTRUCTION Of•O 7fs"` L <br /> INSTALLATION WILL SERVE: KRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NVMBEROFBEDROOMS: NUMBER OF EMPLOYEES: �1 <br /> IR SEPTICTANK TYPE/MFG Ssl�/ CAPACITY� gal #OFCOMPARTMENTS ? <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL �� ' Il FOUNDATION R PROPERTY LINE G R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLO�,SE�tD SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES �_ LENGTH OF LINES <br /> DISTANCETONEAREST WELL RC7 R FOUNDATION NO' 11 PROPERTY LINE t( I It <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL D FOUNDATION H PROPERTY LINE Il N <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R (' <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R 4) <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE H L- <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH tl <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> SEEPAGE PITS WIDTH -ZC, 11 —R LENGTH R DEPTH �aS' R �^ <br /> DISTANCE TO NEAREST WELL %j S' R FOUNDATION 1105 ' R PROPERTY LINE SCS Il <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, 1 <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. j <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIOjjNS—_-PLEASE CALL(209)953-7697 l <br /> SIGNED TITLE ���/. DATE <br /> O <br /> D1112, fj <br /> x <br /> I' <br /> R <br /> 5 N 40AI Dul G U <br /> L <br /> DEPARTMENT SE N 1' <br /> Applinlion Accepted B L 4. Date V `3 Area ( Employee ID# �i'(`f 9 <br /> Final Inspection Date ❑ SPECIAL PERMIT-Approved by / <br /> Character of Soil to Dep of 3 Ft: Pit/Sunfp Soil Character: <br /> COMMENTS 1r)[d hrI f -erc -e4 No b,fee- rl a,j-S /•idlc. 4 ,( v old. �-Jce-..,.f <br /> PE SC Received Amount Dale re Invoice# Permit 1D# <br /> Code INFO B ash Remitted Service Re uest# <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> 1212,02 <br />