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L <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SBOE WEBER AVE-3"FL-SYOCNTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209953-769,7, lNSPEcF10NS EXPIRES I YEAR mom DATE ISSUED <br /> JOB ADDRESS ? (- Z- { r �- CITY21P — :�+•. - _ <br /> 11BB <br /> CROSS STREET P ' rrll V \'N^^�1�1�` APN "-I�� I VG / PARCEL SIZE <br /> OWNER NAME ^- uYT F )\- /'�� PHONE <br /> LOWNER ADDRESS CITY/STATEIVP <br /> CONTRACTOR \ PHONE l dol - '�T✓ <br /> CONTRACTOR ADDRESS CT'/SFATEIDP <br /> LICENSE Ll C42 ❑C-16 OTHER NUMBER EXPIRATION DATE <br /> WATERTABLEDEPIH: R GEOGRKNUCALINFORMATION: Coordinate X Y <br /> PERC TEST k BWLDINGPERMIT# LAND USE APPLICATION# _ <br /> TYPEOFWORK: ❑ NEWINSTALWTION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED IALTERNATIVEr <br /> ❑ REPLACEMENT ❑ DISTRUCEION <br /> INSTALLATION WILLSERYE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBE0.0F LIVING O NITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOVETS: <br /> ❑ SEPTIC TANK TYPHMFG CAPACFFY Sal AOF COMPARTMENTS <br /> ` ❑ GREASE THAT TYPEIMPG CAPACITY PI kOFCOMPARTMENT3 <br /> ❑ PEG TX PLANT DISrANCETO NGREST: WELL D FOUNDATION ft PROPERTY LME B <br /> ❑ LIFT STATION SITE TYPEOEPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SISTEM) <br /> ` ❑ LEACH LINES ❑ LEACHING CHAMBERS #DFLIXEs LENGTH OF LNEs fl <br /> DIETANCETONEAREST WELL A FOUNDATION ft PROPERTY LINE fi <br /> ❑ FILTER BED VVIDEH It LENGTH ft DEPFH ft <br /> L DIETANCETONEARPSF WELL B FOUNDATION It PROPERTV FINE ft <br /> ❑ MOUNDED wmTx ft LENOFH It DEPTH h <br /> DISTANCE TO NEAREST WELL B FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS W.-ft LENGTH ft DEPFH ft <br /> DISFANCETONEARFST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS W. ft LENGTH ft DEETH ft <br /> DOE&NCETONEAREST WELL R FOUNDATION ft PROPERTY LNE fl <br /> ❑ SEEPAGE PITS NUMBER W. ft DEErH ft <br /> DIEFANCETONEARFST WELL IF FOUNDATION It PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> B• ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR AD%ANCE NOTICE,REQUI RED FOR INSPECTIONS-PLEASE CALL OIWI 951-7691 r <br /> SIGNED — •- j • '-_-- -' TITLE -_ - -� DATE I <br /> y I <br /> I 1 1 <br /> 1, <br /> 1 I - <br /> N O <br /> V ONIM- <br /> DEPARTMENT LLS OVIP'Y <br /> AMI),zlion Ao,eptetl By_ i' �'i Date ��II J / A. Employee lDk �r � <br /> Find Inspection By - DAN, ❑ SPECIAL PERMIT-Appmved by <br /> Chancier of Soil to Depth of l}Y: INUSump Soil Character. <br /> COMMENTS <br /> 6. <br /> PE SC Rerelvetl _ChsMl-' Amount Po"MN <br /> Cotle drD B UTh RIM DAN,Dal° ServieeR umtp IevoHek Permit IDB <br /> 42-02-001 ONSRE WASTEWATER PERMFF <br /> IL32Q003 <br />