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/Plo ONSITE Wt`�TEWATER TREATMENT SYv'rE r. <br /> �. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTii_-PARTMENT 600 L JN STR TO 468- 0 <br /> NON-REFUNDABLE,P/�ERMIT CALL(209)953-7697 FOR INSPECTIONS XPI F - <br /> Joe ADDRESS `IJP, 71w.S _ /�lJCITYIZIP <br /> If CROSS STREET �JyTL�/Ji ,�'-C�Er �.'� /�/[fi' ,^APN L/7/`J1�.3 6 ��-� PARCEL SIZE � ✓��-'• <br /> OWNER NAME , /e ���57� V� PHONE <br /> OWNER ADDRESS CITYISTATEIZIP <br /> r, �0�, <br /> CONTRACTOR /J U PHONE <br /> CONTRACTOR ADDRESS ?`�� ��, T/D Cm'lSTATE2IP �+G�!/, GI'Y !26 <br /> Il{� LICENSE ❑C-42 11C,36 OTHER NUMBER ExPIRAnoN DATE <br />' <br /> ,I WATER TABLE DfPTN: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# a <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTKIN <br /> a INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> F0 SEPTICTANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> CI GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION-' R PROPERTY LINE R <br /> Q LIFT STATION SIZE -TYPE OF PUMP A PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> FE3 LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINEF, R <br /> O FILTERBED, Worm R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> O DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> I] SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 LAW$AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 J, <br /> SIGNED TITLE DATE 7 �� <br /> Al it) <br /> I O UN <br /> vItlTrAL <br /> AR <br /> 44 <br /> F DEPARTMENT US ONQY <br /> Application Accept Date / LZ9 Area Employee ID# <br /> Final Inspection I ' Date �1 1C� ❑ SPECIAL PERMIT-Approved by <br /> Character of So3I to Degdh of 3 Ft: PitlSump Soil Character: <br /> COMMENTS 5' . . i�r'�i�� C.�3'= 2-j - ss <br /> FPE SC Received Amount Permit! <br /> Code INFO 6 Cash emitted Date Service-Request# Invoice# Permit ID# <br /> z sz1 52 7S' <br /> FONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> I 41D7 <br />