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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3®Fl.-STOCKION CA 95202-(209)468-3420 <br /> NON-REFUNDAHLE PERMIT -. .CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> A <br /> ' ro7ADD `` 1� '"� '��+ ( - � I � aTY/Ele 1 7RAPK - -i-� PARCEL 61ZE 1 - e <br /> OWPHONEOWCITY/STATEIZIP. PHONE <br /> CONTI CTORADDRESS CITY/STATFIZIP <br /> J <br /> L LICENBE ❑C42 ❑C-36 OTHER NUMBER ERPIRAnoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: C..ldf Mcl X Y <br /> PERCTESTB _ BUILDING PERMIT LAND USE APPLICATION# <br /> I{ TYPE OF WORK: O `NEW INBFAL"ON ❑ REPmR/ADDITION ❑ ENGINEER DESIGNER/ALTERNATWE <br /> rl ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: L3 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVING UNITS: NUMEER OP BEDROOMS: NUMSEROPEMPwYEES: <br /> I. ❑ <br /> SEPTIC TANK TYPFIMFG CAPACITY gal kOF CDMPARTmF1ITs i <br /> Y ❑ GREASE TRAP TYPFIMEG CAPACITY gal #OFCOMPARTMENTS rn <br /> ❑ PKG TX PLANT DISTANCETONEARCST: WELL ft FOUNDATION R PROPERTY LME ft <br /> L LILIFT STATION Sim TYPE OF Pump El RAND OIL SEPARATOR(Ercws¢D SYSTEM) r I <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LMEs LENGTH OF LMES R <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Tl <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH It 1 <br /> blee DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLME <br /> ❑ MOUNDED WmTx ft LENGTH ft DEPTH ft Oi <br /> DISTANCETO NEAREST WELL R P0UNDATION ft PROPERTY LME R <br /> ❑ SUMPS WmTH ft LENGTH ft DEPTH ft <br /> ` DISTANCE TO NEAREST WELLR POUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS W.—ft LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUMBER Wmrx ft DEPTH It <br /> ` DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LME ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> L <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 MINIMUM N HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> L SIGNED TITLE DATE 1 <br /> 1 <br /> 6. <br /> 71 r <br /> SAWDAL <br /> I <br /> e I <br /> N AF16E <br /> DEPARTMENT USED Y <br /> 1. �. /f}''1 I/ <br /> APRlimtloo Accepted BY y11.o"1��I'� Date I 7 Arm Employee ID# -- tf i 4/Tl/Yy <br /> V Final laapmtlaB By Date ❑ SPECIAL PERMIT-APPmvel by <br /> CU,.wr of&it to Depth of 3 Fh P6/Sump Soil Character: <br /> COMMENTS <br /> L <br /> PE SC Rersfved Cheddt�- Am(u(t Deo Permltl Invoice# Permit lD# / <br /> Code INPo B ''—ISih Remitted 6ervice Re um[# <br /> 42-02(01 ONSITE WASTEWATER PERMIT <br />