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ONSITE WAS 'WATER TREATMENT SYS1 I PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER ASI: 340 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)X953-7697 FOR INSPECTIONS pAE�rXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ✓��� L� VJo� c t- "'�^ CITY/ZIP 1'+LQ.IAA 1Y2-Z-0 <br /> :I <br /> CROSS STREET �,AW Gw1 99 APN 013 — 7--2-0-57— PARCEL SIZE �2 p <br /> OWNER NAME iC4 W\ � AV%,� A�XAltlib CO \PHONE <br /> OWNER ADDRESS 14 <br /> -o S iAvi, CITY/STATE/ZIP \.OA.`A C%&' <br /> v <br /> 9 <br /> CONTRACTOR 'r k-'r"C- \'c ' PHONE -3Ca 7� -3—to \ <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PC PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# D — I kDS <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <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 LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C\j <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft N <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 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 NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft jC, <br /> 1 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 /> MI UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED A TITLE aM�-V�A2S/1/t DATE <br /> ------ ------------..R.Mt----_---____.__..-----. PR(LNINAV WE PLOT FOR s <br /> MOOSE WTOOOR WORTS 'S OLOR <br /> It <br /> 1 qj i I y <br /> ON <br /> SAN <br /> c U <br /> 1 f LTJ <br /> DEPARTMENT USE NLY l� <br /> Application Accepted By Date 4--!L&_10-7 Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENT , <br /> PE SC ReceivedChe Amount Date Permit/ <br /> Date Permit ID# <br /> Code INFO Cash Remitted Service Request# <br /> �22z S-2-1q� co Z L(C7 <br /> 42-02-001 ONSITE WASTEWATER PERM]1 <br /> 12/22/2003 <br />