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-,w-"C` <br /> ONSITE WASTEWAT R TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN QOUNTY ENVIRONMENTAL HEALTH yDEPARTMENT304E WEBER AVE-3"FL-STOCETON CA 957 209)46&3420 <br /> NON-REFUNDAB PERMIT CALL 2. 53-7697 FOR INSPECTIONS EXPIRES I YEAR FR&M*ATE ISSUED <br /> JOBADURFSS D Mi-4i 9-0" CnYrLIP <br /> CRDSSSTREEr APN O I I -11-0-r o Z- PARCELSIEE. V l_ .� a <br /> OWNER NAME byT4 4.4 L\I PHONE 201-321, I�io <br /> OWNER ADDRESS 'r4 1 �- y—IL �+ I Co Ny CITY/STATE/ZIP L-O47 I `rlL <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS OZS CITY/STATF/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER it NUMBER EXPIRATION DATE <br /> WATER TABLE DEPOT: ft GEOGRAPHICALINFORMATION: CODDHI[etea X Y <br /> PERE TEST p BUILDING PERMIT# LAND USE APPLICATION# 2 <br /> TYPE OF WORK: ❑ NEWINSALLATHIN ❑ REPAiWADDmoN ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNRS: NUMBEROFBEDROOMS: NUMBER Of EMPLOYEES: .+ <br /> ❑ SEPTIC TANK TYPE/MFO CAPACITY Ssl #OFCOMPARTMENTS ` <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ PKC TX PLANT DTSTANCETO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION Sue TVPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH It DEPTH It <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH B LENGTH ft DEPTH ft <br /> DLSTANCIETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R J <br /> ❑ DISPOSAL PONDS WtmH R LENGTH ft DEPTH R <br /> DISTANCETONEAR sr WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION ft 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. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CAJL�L(209)953-7697 lv <br /> SIGNED TITLE Co..�.C.n _.\� DATE <br /> C <br /> Y <br /> UN O <br /> H <br /> DE RTMENT EON V <br /> ApplicaHon Accepted Dale 11 Area Employee lD#_C% %�—/-1' 1 <br /> Final Inepeclion By Date ❑ SPECIAL PERMIT-Approved by <br /> CharBakr Bf Soil ID DII o173 Fl: PiVSump Soil Character: <br /> COMMENTS ✓`//CIF — C <br /> a,<2- <br /> z2ae epi <br /> PE I SC RecdvW « Amount Date Permit/ Invokep Permit lDp <br /> Code INFO B ash RendltW ServieeR ,.t# <br /> 2 ?� µa 90 4sPD$ Z <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1✓222003 <br />