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L <br /> LONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> L SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 344EWEBERAVE-3'FL-SYOCKTONCAM202-(209),6664420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIO%S EXPIRES I YEAR FROM DATE ISSUED <br /> Joe ADDRESS ''7 G 1 `-'I C 1) l' 1`. C.Arl, ^t„�.._ <br /> CROSSSFREET r C APN - G " I'•J' `� PARCELSIM4 /I <br /> L OWNERNAMe `a• P'�. �.. r' _.-I PHONE <br /> OWNERADORE53 �' T' L jy ..� •-\ f Yr_ (` C CMISTwTwZIP LI I\JP w C T) 1Y <br /> COHTMGTOR P\' r` J PRONE <br /> L COMMCEOR AODRE83 T 1� �- CITVISTwTF/ZIP i � 1 � � <br /> LICENSE ❑C-02 ❑Cd6 OTHER LAUNDER E%PIRATION DATE <br /> WATERTABLEDEITIG ft GEOGMPHICALINFORRATION: CMIGUI UB:e % Y <br /> L <br /> FERC TEST % BUILDING PERMIT$ LAND USE APPLICATION$ ,,-H <br /> TYPE OF WORK: ❑ NEW INBEALWTION ❑ REPAIR/ADDEDON ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> p ggP1,ACEM[M ❑ DEsrRurnON <br /> IN ON WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> LNOMBER OF LIVING UNGEG NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMEG CAPACITY gal 4OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFC CAPACITY Ral 4OFCOMPART FLATS <br /> ❑ PKG TX PLANT DISrANCETONEARESE: WELL R FOUDATIUN ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE Tm OEPUMP ❑ SANDOILSEPARATOR(ENCLOSEDSVBEEI) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBER6 40FLINES LENGIHOFLINES ft <br /> DISEANCETONEARE4T WELL R FOUNDATION ft PROPERTY LINE R <br /> L ❑ FILTER BED WIDTH ft LENGTH ft DEPN, fl <br /> DISTANCETONEARPST WELLft FOUNDATION fl PROPERTY LINE fl <br /> ❑ MOUNDED W.. R UNGER ft DEPTH fl <br /> DISTANCETONPARPST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> L ❑ SUMPS WID R ft LENGTH ft DE <br /> DISTANCETONEAREST WELLft FOUNDATION R PROPERTY LINE R <br /> Cl DISPOSAL PONDS WmIR ft LENGTH R DEPTH fl <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTYLINE ft <br /> ❑ SEEPAGE PITS NUMBER W. ft DEPTH fl <br /> L DISTANCETONFAREST WELL ft FOUNDATION I PROPERTY LME ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ,MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-0697 <br /> LSIGNED — TITLE DATE <br /> 1114'.Lkir <br /> 5N O IN O A <br /> L VOM <br /> 4 <br /> H I I I LA <br /> 4 <br /> L f <br /> Lf / Date DEPARTMENT US IefJ'ON V <br /> APPlimtlon Am,pUdBy ---' L"^'�� II 07 A`eA E IKIID4 'SJ <br /> FlRel inep¢tlan By D+te / ❑ SPECIAL PERMIT-AWNIxlby <br /> Chameler of Soil to Depth of3 Ft PIUSump SNI Chander: <br /> COMMENTS <br /> PE SC R—I— Amount Permit/ <br /> Code N. <br /> f B CMh Remitted Daft ServlSN PeH4 Invokeq PermI11DM <br /> Z <br /> (INSITE WASTEWATER PERMIT <br />