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LONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JIM WESERAVE-3"FL-STOCKTON CA 95202-(209)AM-3020 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS '•.•�' I ...Y <_I �, •) _... . cm21r - k _,. <br /> CROIAMEET =�.)� N 11 ! APN )2s'- _ PARCELSIEE-. 1— <br /> L OWNER NAME f L� L f ^f S� PHONE - <br /> O.MAODRESE 11�� }� / •�-L4i I v CTTY/STA'1'rJLIP <br /> CONTRACTOR 1�, PHONE <br /> L COMRACTORAOORESS - C.MATTJZIP IA <br /> L 0C42 0C-36 OTHER NUMBER E%MRATION DATE <br /> WATERTAII DEPTN: ft GEOGRAPHICALINFORMATION: CWrEInMer X Y <br /> ❑' PERIC TEST # I BUILDING PERMIT# LAND USE APPLICATION#'l <br /> TYPE OF WORK: ❑ NEW IN3rALLATION ❑ REPAIR/AODRION ❑ ENGINEERDEMGNED/ALTERNATIVE <br /> ❑ REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROF LIVING UNITE: NUMBER OF REOROOMS: NUMBEROFEMPLOVEFS: <br /> 1 ❑ SEPTIC TANK TYPVMFc CAPACITY gal NOFCOMPARTMENTS <br /> L ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION It PROPERTY LANE fl <br /> O LIFT STATION SIEE TYPEOFPUMP ❑ SANDOILSEPARATOR(ENCLOMDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINE9 LENGTHOFLINFS fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATON It PROPERTY LINE fl <br /> ❑ FILTER BED WmTx ft LENGTH R DEPTH fl <br /> LDISTANCETONEARMT WELL A HANDATM ft PROPERTY LINE <br /> ❑ MOUNDED fl <br /> W.. ft LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL ft FOUNUATON It PROPERN LINE 0 <br /> ❑ SUMPS Wlmx ft IENOTn ft DEPTH R <br /> L DISTANCETONEARE41 WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wortx ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH fl <br /> DISEANCETONEARE4r WELL fl FOUNDATION ft PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WEEK SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL 12091963-7697 <br /> LSIGNED TIME DATE <br /> 1. F1 I L - <br /> N <br /> H E <br /> i/ DEPARTMENT USE OILY <br /> Application Accepted By -" Dale H9'L( A. EmplOyce IM <br /> Final Inspection By Data ❑ SPECIAL PERMIT-Appmvei by <br /> Character of Soll IR Depth of 3 FU PIUSump Soil Character: <br /> COMMENTS <br /> PE SC Rett11 "111Amuurt MIA PermiU 1BYDice# Permit IDN <br /> C##e I. B Grh RemlRe# ServICeR Dmt# <br /> 42-0Lp01 ONSRE WASTEWATER PERMIT <br /> IMMUOl <br />