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r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 306E WEBER AVE-3"FL-ST OO[TON CA 95202-(20)"IUM20 <br /> NON-REFUNDABLE PERMIT c CALL 209 953-7697 FOR INRPECTIONN EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS r-I 1 _ 4.. L.1 ¢_ f ,p e-. CrtYmP ;_.., V _ I s A� - ✓ <br /> ` CROSSSIREET - - ` 1 APN >"^ PwRCEL SISE Z�q.Zq�J p <br /> OWNER NAME PHONE IO UIO-� 11 1 <br /> OWNER ADDRESS ` 1 CITVISTATF E t <br /> ` CONTRACTOR N:7 �' PHONEy'1 <br /> CONTRACTOR ADDRESS CrtVISTATTJZIP rIJ <br /> LICENSE ❑C-i_' ❑C-36 OTHER NUMBER EX%MTION DATE <br /> WATER TABLE DEPTH: D GEOCRAPHIFALINFORMATION: C98TNnetee X V <br /> BIBB <br /> _p PERCTEST R BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPAIRIADDITION ❑ ENGINEERDEMONED/ALTERNATIVE 1 <br /> ❑ REPLACEMENT ❑ DERESH.. <br /> INSTALLATION WILL SERVE: ❑ REvoENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOVE. <br /> ❑ SEPTIC TANK TVPUMFG CAPACITY pl #OFCOMPARTMENTE I <br /> ❑ GREASETRAP TYNUMFO CAPACITY Pi #OFCOMPARTMENIS <br /> ` ❑ PKG TX PLANT DISTANCETONEARESY: WELL A FOUNDATION It PROPERTY LME ft <br /> ❑ LIFT STATION Sin TYPE OE PUMP ❑ SAND OIL SEPARATOR)ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMSERS #OFLMFS LENGTHOFLMEs ft <br /> 6. DULANCETONGRTST WELL R FOUNDATION fl PROPERTY LINE R `' <br /> ❑ FILTER BED W. ft IENcTN ft DEPTH ft <br /> DIBTANCETONEAREST WELL IN FOUNIATO. fl PROPERTY LINE R <br /> ❑ MOUNDED W.. R LENGTH ft DEPTH R <br /> DISFANCETONEARESP WELL ft FOUNDATION R PROPERTY LME It <br /> ❑ SUMPS WwT'N ft LENGTH ft DEPIN R <br /> DISTANC'ETONEAREST WELL ft FOUNDATION fl PROPERTY LME ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DIETANCETONEAREST WELL R FOUNDATION fl PROPERTY LME R <br /> ` ❑ SEEPAGE PITS NUMBER WIHTH R DEEL i R <br /> DISTANCETONEAREET WELL ft FOUNDATION fl PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY / <br /> ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I <br /> 6. MINIMjjUM 26 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 120619134697 <br /> SIGNED _-^i-. -�_t ii'�I TITLE DATE + <br /> V <br /> 6. <br /> 6. <br /> i A ' <br /> T N T V <br /> E <br /> � I <br /> L �(/., �( DEPARTMENT <br /> APPIHRIwn A.1pt,I By G �R.` `H-G— MI. �n /1(T Ares Employ. <br /> pi..]lnlpection ey DRte ❑ SPECIAL PERMIT-AppwvVd by <br /> ` Chaneter of Soil w Depth BU FL PIVSump Solt CGmRCHv <br /> COMMENTS <br /> ■.I PE SC Receive) CheCltll/ Ameune DUN, PerMtl Invoice# PermR IM <br /> Code INFD By -£B Remitted I I SerVi.R'.9 0 <br /> ` 12-034)(T ONSITE W AETEWATER PERMIT <br /> 13R 2003 <br />