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00 1 <br /> ONSITE WASTEWATER TREATMENT SYSTEP ERMIT f9 lD.,eo <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEM 301E WEBER AVE-Y'PL-STOCKTON CA 95202 .(209)4"11420 <br /> NON-REFUNDABLE PERMIT CALL(209)933-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JORADDRESS TtSdr.4Cm2Hy <br /> N <br /> CRoSSSTNEET COMb•9A.. APN pZ9T'- /nOvI9 PARCELSIEE <br /> /E 1 I A 2 aJS G <br /> ne <br /> OWNER NAMe -AUGI cz.-rdn-7 PRONE <br /> OWNERADDRERi tial ar. Ar cm/STATVLIP s9i1i- A 441,4a-A <br /> CONTMCFOR uaMti C)W Y(/r..r. <br /> PHONE <br /> COMWLTORADDRCES CITY/SFATEJ/AP <br /> LICENSE 11 C42 (3 C-36 OiNE0. NUMBER EX%MTON DATE R� <br /> WATER TABLE DEM: R GEOGUPRICALINFORMATION: Coordimta X y <br /> ❑ PERC TE ST(S) NUMDER LAND USE APPLICATION N V' <br /> TYPE OP WORK: NEWINSFALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDURaNED/ALTERNATIVE I <br /> O REMWEMENP ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL�1 O OTHER <br /> NUMB LIVING ONRS: I1 NUMBEROF BEDROOMS: J NUMBEROPEMPLovxDU �V <br /> or/SEPTIC TANK TYPNMFOT T,� CAPACITY a OOD RBI ROFCOMPARTMENR O VIA <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY RBI ROF COMPARTMENTS 'l <br /> ❑ PKGTXPLANT DLTI'ANCETONEARESI: WELL l6tI fl FOUNDATION NJOApUI tYKTYy6l._E <br /> �„ ,jr(pEPPAAAATT1M ft <br /> ❑ LIFT STATION BIEE TYPE OP PUMP ENVY ( NCLOSEDSYSTEM) <br /> Y LEACH LINES ❑ LEACHINGCHAMBERS OF LINES LOfdY�111Y1efi.DBTIREI Glen FB'R <br /> DIBTANCETONEAREST WELL Its + ftT t»IORIt6FIM10ONIP. 9-11101' R <br /> (3 FILTER BED W. fl LF. D(IAP 10-YAO ree�quire An R <br /> DISTANCE ro NEAKEn WELL ft FOUN AnON ft4BB R Ieum TOf01pT—ft <br /> ❑ MOUNDED WIDTH R UNGER pFlDe p 2. Mwm —R <br /> DISTANCETONEAREST WELL ft UN" C ft <br /> ❑ SUMPS W. ft LESErm DErtH It <br /> DISTANCETONMEDrr WELL ft FOUNDATION ft <br /> ❑ DISPOSALPONDS W. ft LENGTH ft DEPTH ft <br /> / DISTANCE TO NEAREST WELL ft FOUNDATION ft PR ft <br /> V" SEEPAGE PITS WIDTH �{l9JJ R LENGTH -,& 3 ft DEPTH It <br /> DISTANCETONEAwtwr WELL_jS& _,ft FOUNDATION ZVI1I R PROPERTVLINES ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN J04QU)N COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I <br /> INIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION$-PLEASE.CALL(209)953-7697 <br /> SIGNED TITLE 04JrN DATE Yl_%6-n:� <br /> A <br /> I VE <br /> -20 <br /> 1 <br /> O <br /> MNT L <br /> 4rm - DEEARTMENTUSEONLY <br /> ApplkMbo Accepted B �F. DBk /(-,7- 17 V j Aree Employs ID# <br /> PleBllmpert cc By Date / ❑ SPECIAL PERMIT-Appmvdby / <br /> CM1Bncter of Souto Dep of3FU PIUSRmp So(I ChEneler: <br /> COMMENTS RS-SQ'6( -11-?009 7**!rr-%21:ae 7-Le,, Jew&ye/ i7,PA7!/LATE' 1 A -C 5; r&- 7- DR4JAl <br /> _hle4c6� 4-a <br /> PE SC R..4l d ChMWD Am9mq Permit/ <br /> de <br /> CoIRro B n <br /> CM1 Rt.UI&d DBIe $ervke Re ue4R Involcep Perm111DN <br /> ytl 11-7 1 Z)V� Z03bLl <br /> 1308 <br /> 4241L 1 ONSITE WASTEWATER PERMR <br /> Imm <br />