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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOLKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7997 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOB AoOREss CITY2IP - <br /> �� CRoss STREET APN Pu 3a 4 Ei <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CMISTATE21P <br /> CoNTIACTGR PxoxE <br /> CONTRACTOR ADDRESS C ro fC CMISTATE2P <br /> LICENSE QC-42 QC46 OTHER NUMBER EXPIMTION DATE <br /> WATEII TABLE DEPTN: ft GE00RAPxIGLL INFORMATX]M: COOIdinINIB 7( Y <br /> _ PERC TEST • ( BUILDING PERMR JI LAND UBE APPLICATION N <br /> E UFFW G ❑ NMMBTu"Tm RenuNboITIDN ❑ ENOINEERDESIGNED/ALTERNATIVE <br /> r l ReKACEMBrt ❑ DEBTRUOtgN <br /> INSTALLATION WILL SERVE: ❑ REtiIDENM 0 ^ ❑ OTHER <br /> NUIMIEAOFLNNGUN : NUMSMOPEEDROOMS: NUIMIEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYPNMFG CAPACT/ gal MOFCOMPARTMENTS <br /> O GREASE TRAP TW4JMFG CAPACITY gal NOF COMPARTMENi'b <br /> DOTAN MNE ST: WELL ft FOUNDPTXN ft PROPERTY LINE ft <br /> 13 LIFT STATION SUE TYPE OF PUMP D WEI TK PLANT O SANDaLSEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS 60F LINES LENGTH OF LINES ft <br /> DISTANCE M NEAREST WELL ft FOUNOATION R PROPERry LINE R <br /> ❑ FILTERSED WMTH R LENGTH ft DEPOT It <br /> DwANCB TO NEAREST WELL ft PWNOA I ft FeopERIY UNk ft <br /> (3 MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LIME ft <br /> ❑ SUMPS Wotx It Lemarm it DEPTH ft <br /> DUTmM M NEAREST WB-L ft FGUNOAT,oN It PtOPER1Y MNE ft .. <br /> ❑ DISPOSAL PONDS WIoTN ft LENGTH R DEPM ft <br /> DISTANCE M NEAREST WELL ft FOUNDATION R PROPERTY UNE ft ') <br /> ❑ SEEPAGE PITS NUMBER Warm It DEPTH R <br /> DISTANCE M NEMEST WBL ft FOUNDATION It PROPERTY UNE It <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ARD THE WORK WLLL BE DONE IN ACCORDANCE WITH SAN JOAWN COUNTY ORDNLAti , <br /> STATE LAWS AND RULES AND REGULATIONS OF BAN JOAWIN COUNTY, <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)863.7897 <br /> TITLE -.lG'h"-i•._ DATE IIS <br /> I 1 14 1 1 1 1 A I I IF <br /> I <br /> tNT <br /> ED <br /> 2009 <br /> -_:DEPARTMENT USE ONLY �fyy ENVIRONMENT NN <br /> Application Aoeepted BY I f L �Y - DRB Area Employee IDNE'N OF,PfIRTM�F7 <br /> Final Impaction By Geta ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of I R PW Stomp Sok ChMMCGr: <br /> COMMENTS <br /> Cato Npp Raplvad CtcM Amount FOC <br /> Cash RemlSad DBIB sB iw IV i ITIvpInB PaImkIM <br /> 42gt CNSITE WASTEWAYERTRTMNT SYSTEM PERMIT <br />