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ONSITE WASTEWAT T>71VIENT SYSTEM PERMIT <br /> SAN JOAOtMM COUNTY ENVIRONMENTAL HEALTEt QEPART61ENT /' 1868 E.HAzELTON AVENUE-STOCKToti CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(�09)953 �F INSPECTIONS EXPIRES 4 YEAR FROM DATE ISSUED <br /> JOB ADUREBs ---L i �},_. .L- ._...-_._-. --�.1t1/--- CRL <br /> CITY/ZIP- _Ax*r JL--- _•�� �; <br /> CROssSTREET "p" C'�I �s APIC.v_`_3fS� --- PARCEL SIZE �o <br /> PHONE <br /> OWNER NAME._- <br /> OwatERApnREss1��.-� -- --CRY/SrATEIZp <br /> CONTRACTORw <br /> __-_____ <br /> . fes.' r'l -_-"_.S—i.,L .__.. ...__"_. _ <br /> CONTRACTOR ADDRESS -1:L---1-Y•r--. : ii T.< 1-4--__--_--.'- -.__-__-CllYl5TA7E/GP s^,r'.....__ -. <br /> f�G 4 L% <br /> LCENSf "'C-42 s.-..-C-36 OTHER..____ — NUMBER V .._ __�.E%PMIATKIN DATE.._._..__.. -_-. <br /> -— <br /> WATER TABLE QEPTH: - 35 �__..-11 GEOGRAPHICAL INFORMATION: COOtdlnat03 <br /> PERC TEST #_�----- E3iflLQtliG PERMIT#-- _ .. - _--LAND USE APPLICATIONREPAIR #---- - t <br /> I --'-" ENGINEER DESIGNED/ALTERNATIVE <br /> TYPE OF WORK: NEW HISTALLATION OUT-OF-SERVICE <br /> - t <br /> REPL.ACEAIENT OtIT-OF-SERVICE SEPTIC SYSTEM '' DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL __:, OTHER__tMSER OF ExPLOYEEs: — <br /> NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS:-__- <br /> Nc <br /> SEPTIC TANK TYPFUFG `_'-�J ' CAPAGI'IY _ gat ft0FCC*APARTTAENTS__.--- <br /> ZI GREASE TRAP TYrC?A,G _-_ __ __ CAPACITY _ _ _ gal A OF CIUWARTMENTS. <br /> DISTANCETONEAREST: WELL - ____- it l-Ot1NDAT'ON -_ it PROPERTY LINE _ -.it <br /> ❑ LIFT STATION SITE -_.__-TYPE OF PUMP_----- O PKG TX PLANT O SAND M SEPARATOR(ENCLOSED SYSTEM) <br /> 0LEACH LINES LEACHING CHAMBERS _-.___ --- #OF LINES LENGTH Or`LINES u _ it <br /> r._ <br /> DISTANCE TO NEAREST WELL_ I% ._.._. it FOUNDATION "'�� •" --ii FROPERTY LINE -%"'-' y it <br /> 0 FILTER BED WIDTH._--_- _ R LENGTH _.___ _ {i DEPTH it <br /> DISTANCE TO NEAREST WELL___" - _._ it FOW+DAttOra. R PRCN'ERTYLM>£_ -_---_ti <br /> U MOUNDED WIDTH_____.____ _______(( LENGT!{—__.—�_._--- —0 DEPTt -- -----------R <br /> DISTANCE TO NEAREST WELL_____._.._... _ It I"OUNDATION --_—_-..,.it PROPER"TY UNE it <br /> ❑ SUMPS WIDTH____.___ ._--_it LENGTH_-_._.__.____-__ it DEPTH -it <br /> DISTANCE TO NEAREST WELL__-___-__.. it FUliF.DhTiON -.__-...h PROPERIYUNE-___-__-.__..____ft <br /> Li DISPOSAL PONDS WIDTH ----ft LENGTH,"-.....--_—_--_-- _it DEPT?i-- it <br /> DISTANCE TO NEAREST WF-,L_-__.,_- It t-UNDATION ___-_.__-._it PROPERTYUNE -_it <br /> IG SEEPAGE PITS NUMBER--"_-.`i_.._ WIDTH_—._..1. R DEPTH. -2.-% _ it <br /> DISTANCE TO NEAREST WELL I�EC±_-- It VOUNDADON ('20 it PROPERTY LINE ._S`t r- Y: it <br /> I HEREBY CERTtFY�THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOACWM COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(289)953-7697 <br /> TITLE DATE <br /> SIGNED - <br /> t ' -'T-T <br /> 1 <br /> • ..rte i .:. <<. 3,, � I <br /> t` <br /> i <br /> DLFAF7A-;C USE u•ivL'f <br /> Application Accept - _ Datc,�� _� Area /,rj�_ EmplDyee 1DX <br /> Date_ 4 SPE t PERMIT-Approved by ___-- <br /> Final Inspection 8y,_ _ _ ----- _ <br /> Character of Soli t jo�f�3 FV--- ---- -- - P urlip Soil Characl�: <br /> COPrtMENTS ter _�1r� 9 - <br /> } PE } SC Received CheekMl Amount Dam -_—P invoice it Permit IDI! <br /> Code tNFo B Cash Remitted ! Service Request C <br /> • I r,�-.: !L'G-i. r '`.' .1(,G<S'7`I„!}' :lJ `3'L'-i -Y' 'J� 3 a�SE,•% �.;< sY.f'i:.:�'�)N TU STEW `r ITITA..`.. gTiiwPEWl i- <br /> 42-01 - - ONSITE WASTEWATER irITM..,_e�:E-M PEAIIrT = <br /> •.. ;2 tt;,,; `''f'r�T"z._- �r'` ss-�` '/�}�i; ��jG•'u!Yfl� n <br />