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r <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL. 20 9 -7697 FOR INSPECTIONSXPIRES l YEAR FROM DATE ISSUED <br /> ' JOB ADDRESS , al7 •� ed CITYIZIP CA <br /> .} n <br /> CROSS STREET ff6aull ill APN �ZSS =3� _/'}PARCCEEL SI7.E 6-1 /ae . p <br /> OWNER NAME J V�Iv� �� U PHONE k;7 7J--9 /tea L y <br /> OWNERADDRF-SS CITY/STATE/ZIP SAC& <br /> CONTRACTOR P-ON <br /> CONTRACTOR ADDRESS CITY/STATFJZIP <br /> LICENSE ❑C-42 -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 INSTALLATIONREPAIRIADDITION C1ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: j NUMBER OF BEDROOMS: _ NUMBEROFEMPL.OYEES: <br /> ❑ SEPTIC TANK TYPE/MFG / EWJ r • CAPACITY I I�Pl +� <br /> 7[ _ _ $sl #OF COMPARTMENTS a <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY 8a1 #OFCOMPARTMENTS <br /> al? ❑ PKG TX PLANT DISTANCETO NEAREST: WELLft FOUNDATION ft PROPERTY LINE <br /> • ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBER #OF LTN• LENGTH OF LINES _ �N <br /> DISTANCE Rt WELL 8 �FOUN TIOO_R PROPERTY LINE 8 <br /> FILTER BED WIDTH R LENGTH ft DEPTH � 17 <br /> R fi <br /> DISTANCE jo NE EST WELL FO DATION 8 PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ SUMPS WIDTH ft LENGTH - It - DEPTH. fl <br /> DISTANCE TO NEARESTtl FOUNDATION <br /> WELL It PROPERTY LINE ft "`••••��� <br /> ❑ DISPOSAL PONDS WIDTH ft LENOrH _ ft DEPTH ft y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME ft fJ <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH 11 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE R C, <br /> '• 1 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 /> • INI 24 HOUR ADVANCE Nf I'ICE:REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7647 �T <br /> SIGNED TITLE �•(N A7E„Q DATE .2•-�Q —0 <br /> ♦. <br /> Q. <br /> tr <br /> I <br /> C <br /> M <br /> L LI—L- <br /> -DEPA�(e <br /> MENT USE NL <br /> Application Accepmixth <br /> y Z & Area Employee fD#Final Inspection B te ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil of 3 Ft: Pi wap Soil Character: <br /> COM .,NTS b t­`)0-6r aY'1.aG. C.q,?...,:) ,(/O f J6 LL v.NJ S EA-r'F--z� j/..19Lc2 S4 C.0 V 71P...I4'G Z.4— <br /> PE <br /> .ZPE SCReceived Chec Amount Dare Permit/ invoke# Permit ID# <br /> Code INFO BY ash Remitted Service Request# <br /> G­ <br /> 4202-001 <br /> }4202-001 ONSITE WASTEWATER PERMIT <br /> 12/21'2003 <br />