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LJNbl i t VVA51 twATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)4683420 <br /> NON-REFUNDABLE PERMIT ft-f— <br /> 2009 95^3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS� 7 /n 1�r"I 1-O S(A- --4> CITY2s <br /> IP ���i�- /5-ZO r y <br /> CROSS STREET JnE�C_'T1�"J APN 1 13-OTC :14,-,P --7(e PARCEL SIZE (3--1 A o <br /> OWNER NAME L)f"t-'ice V`--n2-Al L-ET7-S C/0 7 ITG l�I�YtTL.Q PHONE 4-1ID - -1LiO ' <br /> OWNER ADDRESS ZGrat 1 V"\A-&-N0LIfY. CITY/STATFJZIP CSc-&L-o"i , CA `f-r3'2,o <br /> CONTRACTOR L•(JC 0 e- GE06o�jV112.ONYite7-f-j ,KL PHONE 3(pci-031T <br /> CONTRACTOR ADDRESS q0-) w• 0•'N{L ST• CITY/STATE/ZIP LO D t cA y,7-40 <br /> LICENSE QC-42 CC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # lI BUILDING PERMIT# LAND USE APPLICATION# <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 /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> C3 'V T <br /> FILTER BED WIDTH ft LENGTH ft DEPTH �D <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH J V I �O�O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE AAt `ft <br /> E3 sumps WIDTH ft LENGTH ft DEPTH Q�,(fN <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE�A1 Tom•�I{7 N C0147), <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ftFNT <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE PR-QJ• W 6'/Z DATE L—1 L- <br /> 0-'. <br /> -0. a •.,ti vw <br /> J �• <br /> DEPARTMENT)US9 ONLY <br /> Application Accepted By�fv� Date //I l'Da Area / / Employee ID# S <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Amount Date Permit/ Invoice# Permit 10# <br /> Code INFO B , RemittedService Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />