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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> L $AN JOAQUIN COLENVIRONMENTAL HEALTH DEPARTMENT 304EWEBERAVE-3"PL-STOCKTDNCA95302- (109)0 3I20 <br /> NON-REFUNDABLE PERMIT- CALL(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOiADBRr56 I - > `-''Ele.vl�i' Zd. CrtYILr11" 1- �'CU c1cp-lo <br /> zy?D - Y3 PARC`ELSFLE (j,W Ac,cl S <br /> L OWNER NAME CJI\L I\ IV\ •1 yy�PHONE(Z�C1� J�1 ZC4I(pa. <br /> OWNERADDRESs IU"2S W W-'� �. r(?, Y3�� CRV/STATEIEIr I IJItT''f,] C(l C\Sb50 <br /> L -CnrraACOR OF PHONE ��1f1'31J1 <br /> OONFRAROR wopaesE CITYISTArFIZIe <br /> LICENSE ❑CA2 0C-36 OTHER NUMBER EXPIRATION DATE <br /> L WATERTAFLEDEPEN: It GEOGRAPHICALINFORMATION: Caortllnatn % Y <br /> PERC TEST # L BUILDING PERMIT III LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INRTALWTION ❑ RSPAIRIADFITION ❑ ENGINEER DESIGNED IALT ATVE <br /> ❑ REPLACEMENT ❑ DL4TRUCTION <br /> L INSTALLATION WILL SERVE: (3 REHE <br /> SIDENCE ❑ COMMEIICIAL ❑ OTR <br /> NUMB[R OF LIVING UNM: NUMBE0.0F BEDROOMS: NUMBER OF EMPLOYEE4: <br /> ❑ SEPTIC TANK TVPF/MFC CAPACRY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTE <br /> L (3PKG TX PLANT DISANCEEDNEAREST: WELL it FOUNDATION ` - R PROPERTY LIKEft <br /> ❑ LIFT STATION SIZE TYPEOPPuMP ❑ SAND OIL SEPARATOR(ENO..mmv,SYRTEaQ ` <br /> a <br /> L ❑ LEACH LINES ❑ LEACHING CHAMBERS 40FLME9 LENGTHOFLNES.11 <br /> DIMANCETONEAREST WELL ft FOUNDATION ft PROPERTY LNE ft <br /> ❑ FILTER BED WHT. ft LENGTH fl DEPTH fl L). <br /> DIWANCETON A. WELL ft FOUNDATION ft PROPERTY LIKE R <br /> ❑ MOUNDED WIDTH ft -LENOTx ft DEmI ft <br /> L DISFAHCETONEAREST WELL R FOUNDATION fl PROPERTYLNB it <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISANCETONEAmnar WELL _ ft FOUNDATION - R PROPERTY LIKE R <br /> ❑ DISPOSAL PONDS WIDTH - --R LENGTH ft- - DEPTH ft <br /> L DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LME It <br /> ❑ SEEPAGE PITS NVMBaR W. ft DEPTH it <br /> DISGNCETONEAFUI WELL ft FOUNDATION R- 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 /> ORDINANCES.STATE LAWS AND HOURS AND REGULATIONS OF SAN JOAQUIN COUNTY! <br /> L MINIMUM N HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20)953-7697 <br /> SIGNED - TITLE - N DATE I Z L <br /> L <br /> L Y <br /> LJ <br /> O <br /> U At <br /> PA <br /> L o <br /> sy <br /> L <br /> / DEPARTMENT U"E 4NLY <br /> Application Accepted By <br /> ?`--'L-�C L Datal?.r 11 DS Mn ' Employe DO <br /> Final lnapmtw.By - - Date - ❑ SPECIAL PERMIT-Approved by <br /> ` Chac,urr.r oil h Depth Br3F1: Pit'Samp Soil Character: <br /> COMMENTS <br /> I' <br /> ain PE SC Rnel'ad Ch n Anlea9t Mie Etsude Inanin0 Permit lD# <br /> Cade INFO B Cato RemtBM Service ahl p <br /> vZ 22 SZI v (,- \ j a, j -) 3�z.oc l?Inl�� 'o0 c/3 <br /> - <br /> ONSITE WASTEWATER PERMIT <br /> Ran, 11-02-001 <br /> I Y]W) <br />