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�z• � r 2 d <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />�k SAN.IOAQU IN COUNTY ENVIRONMENTAL HEALTH DEPARI'M ENT 304 E W EBER AVE-3-F L-SFOCKTON CA 95202 -(209),460-3420 <br /> NON-REFUNDABLE <br /> PERMIT 'pCALL-,(209)953-7697 FOR h%r,ECTIONS EXPIRES I YEAR FROM I)ATE ISSUED <br /> 1 308 APDRE55 J1t0YYQ �l�Z'AA�L��L 211 5�9R y ClTY17AP <br /> CROSS STREET :.�/_t�y^'�Gl. rJNL- iV �jT� APV �I]--��Y� PARCLLSIZE6�+[34 �a <br /> ONVNERNAME t,�C+ ~� �{ 1�- .w �PHHIOiNE�1J� <br /> ITWNER ABpItE551 __L,% pj ��trnE!�f Y,�fYJf CITYI$TATE7ZIP__. r�&, ��Z. <br /> CONTRACTOR LJ PHONE �CC &1P^$6 2 <br /> CON TRACTOR A DDRESS ti CITVISTATT,IZir <br /> LICFNSE ❑C-42 ❑C•36 OTHER NUMBER EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH:_ 1l GEOGRAPHICALINFORMATION: Coordinates X y <br /> PERCTEST II gUILDINGPERMIT# LAND USE APPLICATION# r Ob <br /> TYPE OF WORK: ❑ NF,W[NSPAt.LAT1ON ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNEpI LTF RNATIVC <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> 1 INSTALLATION WILL SERVE: 0 RESIDENCE. ❑ COMMERCIAL L3 OfHER <br /> NUMBER OF Ll VING UNITS= NUMBER OF BEDROOMS: N UMBER OP EFTPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFGCAPACI(Y gal 4OfCOMPARTMENTS <br /> Q CREASETHAP TWPE/MFO� CAPACITY gal 9 OF COMPARTMENTS <br /> l rr <br /> i ❑ PKG TX PLANT DISTANLx ro NEAREST: WELL R FOUNDATION R PROPERTY LINE <br /> ❑ <br /> LIFT STATION SIZE TYPE OF PUMP Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS N OF LINTS LENGTH OF LINES ft <br /> DISTANCETONEAREST WILL R MUNDATION ft PROPER IT LINE tL <br /> ' -❑ FILTER RED WIDTH It LENG'T'H _fl DEPTH ft <br /> DISTA14CETo NEAREW WELL, It FOUNDATION ft PROPERTY LINE R <br /> ❑ M017NDED WIPTII R LENGTH R DEPTH 9 0 <br /> DISTANCE TO NFARRST WELL_ A FOUNDATION ft PROPERTY LINE ft <br /> I❑ Sl7MP5 WIDTH R LENGTH fl DEATH fl <br /> DIsrANCETUNEARE}T WELL _fl FOUNDATION ft PROPERTY UNE R <br /> Q DISPOSAL PONDS WIDTH R LENGTH fl -DEPTH It Q <br /> DISTANCE TO NEAREST WELL ft FOUN]ATION R PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH (t <br /> DISTANCE TO NEAREST' WELL ft FOUNDATION R PROPERTY LINE $ <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE iN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,grATE LAWS AND RULES AND REGULATIONS OPSAN JOAQUI N COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQl,!IRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE e o— -n.,.. ; DATE . Ao . <br /> fA <br /> 110r,p � N <br /> r <br /> L pc <br /> CAI <br /> 4 <br /> N <br /> r <br /> PAATMF,N7 USE ONL 901, <br /> Application Accepted By Date Area Employ0e ID%�V! <br /> Final Inspection By Date_ J V/DY _ ❑ SPECIAL PERMIT-Approved by_ r <br /> Character of Soll to Dep1h of 3 Ft:. PitlSump Soil Character. <br /> COMMENTS M_e_ =T e.r�.I nr a1�,� 3.vw+ki <br /> ', G sf/ 3 <br /> J.F f-I % ;21,7"71 3.2! � 4-33 . �wraFc axr �i �r.�lu..�rw„C!�'1 ^' <br /> rkI,�t-ff If wa <br /> �E NF Received Ih Armand Date U Invoke 0 <br /> Ir Code INFO B Cash Remitted Service u Permit IDiI <br /> 42-02-001 - ONSITE WASTEWATER PERMIT <br /> 1212212003 <br />