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4 ! <br /> J� ONSITE WASTEWATER TREATMENT SYSTEM PERMT10��Sos-95-7 <br /> SA NJOAQUINCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVF,-3"°FL-STOCKTON CA 95202 - (209)469-3420 <br /> NUN-REFUNDABLE PERMIT CALL(209)913-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS © Al CITY/ZIP <br /> CROSS STREET CAW ino� Iskw APN ���' /.3C� — / t/ PARCEL SIZE , +�Q <br /> 4r � O <br /> OWNER NAME � ,I G � <br /> PHONE � 3.� -3_ y <br /> OWNER ADDWS /J CITYISTATE/ZIP <br /> O <br /> CONTRACTOR PHONE — ��� �• <br /> i <br /> CONTRACTOR ADDRESS .- 1- CITY/STATE/ZIP t <br /> LICENSE C-42 ❑C46 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: OK NEW INSTALLATION ❑ REPAFRIADDFTION ❑ ENGINEER DESIGNEDIALTEFLNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: .�J NUMBER OF EMPLOYEES: 4 <br /> SEPTIC TANK TYPE/MPG 6RkI620=Ird`/�— CAPACITY (� <br /> _ gal #OF COMPARTMENTS • <br /> D GREASE TRAP TYPE/MFG CAPACITY. Y <br /> gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELLQt1 FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATION Size; TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LENES R <br /> DISTANCE To NEAREST WELL FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER SED WIDTH ft LENGTH ft DEPTH ft 1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft }}} <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH }} <br /> DISTANCE TO NEAREST WELL R. FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL, ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH B <br /> DISTANCE TO NEAJREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH Z f( DEPTH _ 2 _ R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE HONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI IUM 24 V <br /> OUR A ANCE.'UTI :REQUIRED FOR INSPECTI 'S-PLEASE CALL(209)953.7697 <br /> 5[CNED /�� TITLE DATEOF <br /> All I <br /> +V <br /> i <br /> J <br /> Li <br /> E <br /> W7-.Ar <br /> I IQM <br /> d <br /> - <br /> PARTM ENT US 'ONLY, r <br /> Application Accepted By Area Employee ID# <br /> Final Inspection By ate ❑ SPECIAL PERMIT-Approved by <br /> Character of Sail to Depth of 3 Ft: Pi ump Soil Character: <br /> CD ENT <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit IDN <br /> Cade INFO By Cash Remitted Service Request# <br /> y Q -Woo �1 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/2212003 <br />