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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 00B NON-REFUNDABLE <br /> JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER APE-3-FL-STOCKTON CA 95202 - ON)468-3420 <br /> NON-REFUNDABLE PERM,,IIT/T�BB CALL 209 953-7697 FOR INSPECTIONSyy,,EXPIR1E� SI YEAR FROM DATE ISSUED <br /> .�3l6iJG -�9J1tii f' f. e— ClnlTAP ✓!sr G u <br /> Jos ADDRESS /j - 1 / <br /> CHOSE STREET 13 pe e.�AJi4.-� APN 2♦0 r-T -'31,0 -00 PARCELSIEE <br /> L OWNER NAME CNLC [�OU49 PHONE <br /> OWNERADINFAS .JUN~� CITY/STATEMP <br /> CONTRACTOR I �' ✓OL PHONE <br /> CONTRAXTORADDRUS CITV/STATEl21P <br /> LICENu 13 C42 0C-16 OTHER NUMBER EXPIRATIONDATE <br /> ` WATER TABLE DEPEN: A GEOCRAPHICALINFORMATION: C"FifinSUN IL V <br /> ❑ PERC TEST # I I I BUILDING PERMIT# - 60.O �� LAND USE APPLICATION# <br /> TYPE OF WORK: NEWIN.ALLATION ❑ AEPAIP/ADDITON O ENGINEERDESH]PUD/ALTERNATIVE <br /> O REPEACEM�E1n�.. ❑ DESTRUCTION <br /> ` INSTALLATION WILL SERVE: a-1RUIDENCE ❑ COMMERCIAL ❑ OTHER <br /> �NUMBeROFL1VINCUNITS: /Jt NUMBER OF BEDROOMS: .� �, NUMBER OF EMPLOYEES: <br /> WSEPTIC TANK TYPE/MFG /t1-- CAPACITY I'TlJf) gel #OFCOMPARTMEMS2 <br /> L ❑ GREASE TRAP TYPVMFG //----.. CAPACITY �y Tom-- gal #OFCOMPARTMEN7-S ' <br /> T�EJ <br /> ❑ PKG TX PLANT DISTANCETONEARE1[J ST: WELL a�a6� ft FOUNDATION J 1 ft PROPERTY LM / <br /> E .S 1 ft <br /> ❑ ��LIFTSTATION Sim_ TWLOFPUMP NDOILSEPARATOREEOS ) <br /> W1 LEACH LINES ❑ LEACHING CH AMBERS #GFL LENGTH OF IVES ubl R <br /> DISTANCETONEAREST WELL ft FOUNDATIO I R PROPE LINE fl <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl {7 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH fl Tr <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft I <br /> ❑ SUMPS WIDTHft LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LME fl <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH fl DEPTH It <br /> DISTANCETONFAREST WELL fl FOUNDATION ft PROPERTY LINE It <br /> g S EPAGE PITS NUMBER I WIDTH 2 fo N ft DEPTHa'S T� ft <br /> DISTANCETONEAREET WELL_ I R FOUNDATION ffSl R PROPERTYLINE 2y R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN CO <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> { <br /> MINIM"UM M HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9534697 II, <br /> I <br /> SIGNED TITLE TITLE�IA A 9tfe C4-fi DATE <br /> 41 JL <br /> �1 Q <br /> IN <br /> QIl V• <br /> I\ E <br /> ( 0 <br /> l N <br /> L E RM <br /> DEPARTMENT USE ON <br /> AppUeadoB Accepted By - DRte 57 1f Aru EmPIoYce ID# T` —S 9 <br /> M..l lnepadon ey Dete ❑ SPECIAL PERMIT-ApP.WSI by <br /> 6. Ch..mT.f Soilto hof3 Pi Sump Soil ChmcMr. <br /> COMMENTS — /J I c J - c re cc-eJ cg'T e F LE. /T <br /> PE SC Received h. AmountDuePermiU InvBice# PerMtIDM <br /> Code IBFO CBFh Remitted Service . III <br /> L *2-.f( 11 Z S.✓ ' S 0 D0 <br /> al-034O1 ONSITE WASTEWATER PERMIT <br />