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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95242 -(209)468-3420 <br /> BION-REFUNDA13LF PERMIT {� CALL 1249]953-7697 FOR 1.'SPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS V r G� �? CITYJZIP 46dd <br /> M <br /> CROSSSTREET eLrr� �. APN__ e��r-130-/l PARCELSILE <br /> �V _ 4 <br /> OWNER NAME 49 � �' Pnone <br /> OWNERADDAESS _,,,/ CITYMATErLip <br /> CONTRACTORiV � F q .moi <br /> PHONE L � <br /> CONTRACTOR Awkucss CIfYISI'ATFJZIP <br /> LICENSE C42 LT C-36 OTHER NUMBER EXPIRATION DATE T <br /> WATER TABLE DEPTH! � � ft CEOGRAPHICAL INPORMATION: COar'dlllatea X Y O <br /> ❑ PERC TEST(S) YJUMDER LAND USE APPLICATION if <br /> TYPE OF WORK: Q NEW INSTALLATION REPAHUADDIT1oN Cl ENGINEER DESIGNEDIALTERNATIVE <br /> ❑ RFMACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILLSERVE: ❑ RESIDvNCE OMMERCIAL ❑ OTHER � <br /> NUMBER OF LIVING UNITS: NUMBER OF EDROOMS: NUMBER or,EMPLOYEES: <br /> r <br /> '90SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFO� CAPACITY pl #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO N <br /> EARF.Sr: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C1 LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SMEM).LEACH LINES ❑ LEACHING CHAMBERS #OF LMFS _ LENGTH OF LINES T d ft <br /> DISTANCETONEARL9T WELL Mt R FOUNDATION `;249' ft PROPERTY LINE e, r ft <br /> CI FILTER BED WIDTHft LENGTH fi DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION III PROPERTY LINE It <br /> ❑ MIOUNDEG WIDTH f1 LENGTH �-ft DEPTH ft <br /> QISTANCETONEAXESr WELL ft FOUNDATION fl PROPERTY LINE ft <br /> 11 SUMPS WDTrx - A LENGTH ft DEPTH ft <br /> D18rANCETONEAREST WELL _R FOUNDATION fl PROPERTY LINE ft <br /> D DISPOSAL PONDS WRmI ft LENGTH ft DEPTH R <br /> DL4rANCETONEARr-S�J WELL ' -jt FOUNDATION ft PROPERTY LINE fi <br /> SEEPAGE PITS WMTx _ft LENoTN r + R DEPTH �5p <br /> �� <br /> f/ <br /> DISTANCE TONAAREST WELLt. /Sd�ft FOUNDATION d ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �'#,j Aga .Ir�l'L V S TITLE <br /> --��q^ �L DATE, �Q_t;t <br /> 1 <br /> I C S <br /> r 9 L 0 ISI6N <br /> .o <br /> ow <br /> 1 <br /> � <br /> DEPAR1rMEN SE O LY <br /> Application Accepted By Date 0 Area Employe1'w1,V1,L7 a <br /> Pinel lmpeeNaa By Date 0 SPECIAL RMiT-Approved by _ ' <br /> ChancteENTS1 la 1`3 PH16-1,S-11 Character. <br /> COMMENTS <br /> PE SC RereEved mo <br /> Che Apal erm i! <br /> Code .0B Cash Remitted Date Serrlcc Re ueat# Inva1 # PermR ID# y <br /> 7 a 003�F 2� <br /> 42-01-001 <br /> 1212*2 <br /> ONSITE WASTEWATER PERMIT <br />