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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOWU1N CouwP ExWRDNMENTAL HEALTH DEIN T NT 600 E MAw STREET-STOC MCA 95202-(209)666-3620 <br /> NON-REFUNDABLE PERMIT 1 p_,�C.ALL 209 953-7697 FOR INSPECTIONS �^'/��. .E�.�%PIlREApS i YEAR FROM DATE ISSUED <br /> JOSADD,um /7-15-1 5% -.pyct:�T77N t. CR mp /•kN I W` <br /> cROSs6TREET vi L-bvo0-01> APK 2o!•ITCJ- 0z P.M. <br /> SaE�(1 r{c . S <br /> OWNER NAM PT{T YA70PE <br /> 1'VU/NQSE� o ONRGy- J'f3TR <br /> Q SNADDREE3 ISI "a(y ,hC.IL Ta/JE cwwATEZP M>hJ.TEcfl 46334 <br /> CONTRACTOR WVE �0/ 1%V. GEOe)%JV)e-0QJMEn2JAL- PHME 31o�i-o33-r <br /> CONTRACTORADDREW ��A463 IN- OT\y-- `T•T • cRY/STATEILP 66DI Gh <br /> LNRNEE QC42 QC416 OTHER NUMBER EYIIRATIONDATE <br /> WATERTAELEDERx: R GEOGRAPxICALINFOPMATpH: C-oDTdi118tes % Y <br /> PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWIKSTAU.ATON ❑ KERNIUMOMON ❑ ENGIXEER DESIGNm IILLTERNATVE <br /> D Rion-, MEMf ❑ DEE =m <br /> INSTALLATION WILL SERVE: ❑ RIEUDENCE ❑ COmmiutc LL ❑ OTHER <br /> NUMEETt OF LIVING UNRs: NUMSMOFBEORO : NUM9EROFEMPLOYEI: <br /> ❑ SEPTICTANK TYPE/MFG CAPA(SIl' gel #OFCOMPMTMEMS <br /> O GREASETRAP TYPE/MFG CAPACffY gal #OPCoMPARTMENTs <br /> DNTAKOEMNPAREsr. WELL A FWNMTIM ft PROF LINE ft <br /> ❑ LIFTSTATKIN SUM TYPE OF PUMP O PKGT%PLANT O SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS OWUNES LENGTHOFLINES ft <br /> DL4TANCE m NEAREST WELLft FOUNMTION ft PROPERTY LINE ft <br /> ❑ FILTERSED WmTM ft LENGTH ft DEM ft <br /> DISTANCE W NEMEET WELL ft FWNMTION ft PROPERTY LINE ft <br /> ❑ MOUNDED Wurlx ft LEND A Dfi ft <br /> DWMCE TO NEAREfiT- WELLft FWNDATION ft PROPER LINE ft <br /> ❑ SUMPS WMTM ft LENGTH ft DEPOT ft <br /> DWmCETONEAIUMT WELL ft FWMATON ft PROPERTYLINE ft <br /> ❑ DISPOSAL PONDS WIm1N ft LENGTH ft DEPTH ft <br /> DISTANCETONIJREST WDLLft FMNMTION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PRS NuNWER WIDTH ft DEPM ft <br /> DISTANCE M NPAREST WELL ft FWNDATION ft PROPERT UNE ft <br /> 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL SE DONE IN ACCORDANCE WTIH SAN JOAQUIN COUNTY ORDINANCES, <br /> `- STATE LAWS AND RULE AND REGULATKINS OF SAN JOAQUIN COUNTY. <br /> PIIMUOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE e-fwsv LTRrJT DATE <br /> 5 b[9GYTEnmRDWNCU' Q <br /> itE c 4 <br /> �zZ <br /> �W <br /> IE z. W N pUZC <br /> W > �. Z W G <br /> g W pow <br /> -,Ar a¢_ <br /> QW > <br /> tiles _ 3 (L Q pz� <br /> - -T� zuJ< <br /> ® Q y Lu <br /> = <br /> �. DEPARIINENT USE ONLY � <br /> App1EOSUon ANmepU I BY \ Date $'2`I'I� Ame 1 �� EmPIOYEE ID# I <br /> Final Dmpm#Em Sr Date ❑ SPECIAL PERMIT-APMm by <br /> ChaneteT of Soil W DepM of 3 Ft PIUSulllp SoU Charaetet <br /> COMMENTS <br /> PE SC Rexivad ChecWN Amount PelmiU <br /> Coda INFO B Cash RmnMed �e SeMee ues!# Invoice# PermN ID# <br /> IWV ONSRE WASTEWATER TRTMNT SYSTEM PERMR <br /> TwaDT <br />