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07so--� 1-,,A4 5t, 6-;LwIG pyre <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCIrTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /yG/s _GL_["='�.. . —._-. CITY21P =GZ0 j <br /> CROSSSTREET _I I.G'+_��. / /� APNI07-t`-'jo/Vp_�j� � / ._._OPARceL SIZ/E c <br /> OWNER NAME�N/iJv�X /YMh/r/ /J4CI�I/L Vt"YA 's'�—L /L P�NO�NEE�/Is ^ypA� V//J c <br /> OWNER ADDRESS �{Q� _ {�"TiT G/I� __....CITYISTATFILIP A"I--LHT /iIl / <br /> CONTRACTOR L VA9114Tr� e- ____,___ PHONE_36 __5_0 Z <br /> CONTRACTORAUDRESS p�5�� 0�5rw QerJc�._.__,_ CITYISTATEILP� �SL147� <br /> LICENSE 134-42 El C-36 OTHER NUMBER S/S40.Y EXPIRATION DATE C'Z/2 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST M.__....._— BUILDING PERMIT# LAND USE APPLICATION#__ <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT <br /> .... OUT-OFSERVICE SEPTIC SYSTEM DESTNIICTION _ <br /> INSTALLATION WILL SERVE: J"E91DENCE '�l COMMERGLM. Cl OTHER____.._ <br /> NUMBER OF UVWG UNITS' I NUMBEROFBEDnOOMS:__?�__ NUMBER OFEMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG FY/Y/w/ i CAPAOTY1 S4� gal AOFCOMPARTMENTS_y++JJ— <br /> ❑ GREASE TRAP TYPEIMFG CAPM ITY_ gal #OF COMPARTMENTS_ <br /> DISTANCE TO NEAREST: WELL it FOUNDATION It PROPERTY LINE fl <br /> ❑ LIFTSTATION SIZE TYPE OFPUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS _ iOFLWES LENGTH OFLINES—_G.D _ it <br /> DISTANCETONEAREST WELL_/w, fl FOUNDATION__19' PROPERTY UNE Aar it <br /> ❑ FILTER BED WIDTH fl LENGTH ._ fl DEPTH_ It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE It <br /> ❑ MOUNDED WIDmN R LENGTH fl DEPTHIt <br /> DISTANCE TO NEAREST WELL—11 FOUNDATION fl PROPERTY UNE fl <br /> ❑ SUMPS WIDTH— It LENGTH _._.....____ fl DEPTH it <br /> DISTANCE TO NEAREST WELL it HARIDAIION fl PROPERTYUNE it <br /> ❑ DISPOSAL PONDS WIDTH R LENOTH __.___ fl DEPTH-- fl <br /> ,,yy DISTANCETONEAREST WELL fl FOUNDATION R PROPERTY LINE fl <br /> CK, SEEPAGE PRS NUMBER 41 Wom 3, ----It DEPTH__,-r, fl <br /> DISTANCE TO NEAREST WELL K T-0UNDATION 9 � R PROPERTY LINE� it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOA INSPECT ON -PLEASE CALL 2099553-7697 <br /> TITLE ._ DATE /✓a3 K <br /> LIA <br /> AT <br /> ED <br /> W Ie C <br /> 3 � G <br /> fONTHAll AL <br /> ------------ <br /> 11 <br /> -L. P E o � �rr <br /> Application Accep Date_ _ —_ Area�Z..q_ Employee IDM Q;Q _._y <br /> Final lnepecdo Cy _ — Data 6 __ fl SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 FL' _ PitSump Soil Character: .___ <br /> COMMENTS� (,C� <br /> PE SC Received Choc Amount Data P.-W Invoice Permh light <br /> Coda INFO ae Remised ServkeR ueati <br /> O II OJ <br /> A2-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />