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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT i `� -_ °'304 V�EBER AVE-3"0 PL-STOCWMN CA 95302 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECT] S EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS G Z iai5 OA) <br /> CROSSSTREET rwL {CL d 4L5 APN ✓LSA]• GE2 C"'-� PARCELSIZE �- �? 4G o <br /> ,nA <br /> OWNER NAMd�F3 Z <br /> F. /,ll E�r� ����j <br /> OWNERADDRESS S> � .ILII /-'/ CrrYISTATE7ZIP — <br /> CONTRACTOR - ' !CL ST-. PHONE <br /> CONTRALTORADDRESS CrrYISTATFJYAP Atar!tE6 C.0 <br /> LICENSE U C-42 Cl C-36 OTHER -- NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH; 510 R GEOGRAPHICAL INFORMATION; Coordinates X Y <br /> ❑ PERC TEST N BUILDING PERMIT# -^U O LAND USE APPLICATION# <br /> TYPE OF WORK, NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT l] DESTRUCTION <br /> INSTALLATION WILL SERVE:- 9—REs1DENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: n NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES; <br /> SEPTIC TANK TYPEIMFG I"�"�-- CAPACITY ^TC10rJ gaI Ik OF COMPARTMENTS - <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gat ROFCOMPARTMENTS <br /> ❑ PKG TX PLANT DLSTANCETO NEAREST: WELL R FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SI7.E TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 2---LEACH LINES ❑ LEACHING CHAMBERS p OF LIVES�� LENGTH OF LINES fl <br /> DISTANCETO NEAREST WELL /60 ft FOUNDATION ft PROPERTY LME (I <br /> ❑ FILTER BED WIDTH R LE H�~ ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R Ay <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH It d <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R r, <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R ` <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPS R O <br /> DISTANCETONEAREgr WELL R FOUNDATION fl PROPERTY LME ft �- <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> 4L�f <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OP SAN'JOAQUIN COUNTY. <br /> is HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE adOOL DATE_6-1-6.5 - <br /> 6 � <br /> ju LAI_ <br /> EP M NT <br /> i t <br /> Ma 5177r— <br /> y DEPARTMENTU <br /> 1 Application Accepted B Date � r L'S Area ,r <br /> � Employee IDIf <br /> Final Inspection By Dile ❑ SPECIAL PERMIT-Approved by <br /> ChrTRcter of Soil to Depth of 3 Ft; PRISomp SDI]Character: <br /> COMMENTS A� w L-CT OF Gal L! . '7S s <br /> - - 4 U - 3D <br /> 1 <br /> PE SC Received Check#/ Amount <br /> Code INFO B DatePermlU IRYoiceM Permit IDN <br /> s Remitted Service until <br /> J-2-11 11-7 t1D 320.00 (a fl Z <br /> 42-02-00 <br /> 12122n003 ONSITE WASTEWATER PERMIT <br /> . <br />