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ON&,,,P WASTEWATER TR*ATMENT SYS7PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT' JIME WEBER AYE-3-FL-STOCNTON CA 95202 -(209)/68${20 <br /> NON-REFUNDABLE PERMIT CALL 209 953-769'A FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> .TOB ADDRESS y'11 �, 0 -.!0> Cmalp <br /> CROSS STREET II W�I U�/E'� ILPN VLI Zoo- 6�!'t" PARCELSIZEA. p <br /> OWNER NAME M. Cie; <br /> / y �teM 1 N l L�.A -� /-P1xonE a c .P " <br /> OWNERADDIUMS 121 B� .7 i `�tiR CYIYNTATPJTJP C `llN 1K J `) `� <br /> CONTRACTOR 1` O W.N.P3lv T <br /> COM'MCTOR ADpR68B O CITVWATPJZIP a <br /> LICENSE ❑C4] <br /> 0C-36 OTHER NIIMOER EENRATION DATE <br /> WATER TABLE DEPFx: R GEOGGPHICALINFORMATION: Coordinates X Y <br /> PERC TEST X BUILDINGPERMITX LAND USE APPLICATION X - O O S- <br /> TYPEOFWORK: ❑ NEWINSTALLATIN ❑ REPAIR/ADDITION O ENCINELR DE4ICNED/ALT[RNATIVE <br /> ❑ REPLACEMENT ❑ DE31AuCTlon <br /> INSTALLATION WILL SERVE: LI RESIDENCE 13 COMMERCIAL LIOTHE11 <br /> NUMBEROP LIVING UNTIB: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: V <br /> ❑ SEPTIC TANK TVPFJMFG CAPACRY EBI #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TPEIMFO CAPACITY Sal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISPANCETONEARESP: WELL ft FoumATpN ft PROPERTY UWE fl <br /> N► ❑ LIFTSTATION Slu TYPEOFPumP O SANDOILSEPARATOR(ENCLOSEDSVBYEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OPLNES LENGTHOFLINES It <br /> DIETANCETDNEAHEEL WELL fl FOUNDATnN fl PROPERTY LME ft <br /> ❑ FILTER BED WIDTH ft IENGD 0 DEFDI ft <br /> DIBFANCETONEAREST WELL R FOUNDATION R PROMTYLNE R <br /> O MOUNDED WImH R LENGTH ft DEM R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLNE fl <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPH fl <br /> DinAN"W NEAREST WELL fl FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WmrN ft LENGTH It DEPTH R �" <br /> " DISTANCETONEAREFT WELL ft FOUNDATION fl PROPERTYLNE ft <br /> ❑ SEEPAGE PITS NumsER WIDrH fl DEPTH ft <br /> DISTANCETONEAREET WELL ft FOUNDATION ft PROPERTY LNE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITS SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUWY. <br /> MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE U,(20)953-7697 S <br /> SIGNED TITLE 6—, C.` 'vNT\ DATE <br /> N <br /> EV rL <br /> L/ f/ DEPARTMENT U. ON Y V/9 <br /> AppIIEatlon Accepted By �- (-L/�('� Dat. mc;h-04ve Ara Employer ILw <br /> Final I..w ion By Date ❑ SPECIAL PERMIT-Applovcd by <br /> Character of Soil M Depth of3 PG PIUSump Soil Character. <br /> COMMENTS f A - aS'OD 8.57 SA <br /> PE EC Rea1YM Ame0n1 PermlU <br /> Cede IPoo Cash esARed U.te SerWm R unt# Invoke X Permit IDS <br /> tiz.zz Sb� I 5'�.-Dv <br /> e2-0 01 ONSITE WASTEWATER PERMR <br /> 1=00 <br />