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% try <br /> ONSITE WASTEWATF` TREATMENT SYSTEM PERMIT 6p �� ow <br /> I <br /> COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3N WEBER AVE-P°FL-STOCKI CA 95 (209)$68.3420 <br /> FUNDABLE PERMIT C LL(2091953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> m <br /> ,DRESS / O LJ e S N CITU/zl�P <br /> .GES STREET <br /> F'I��Q/4 O0-7 0-7 e-y4-Jc PARCEL SIEE p <br /> LI APN 1I <br /> 1/.L 1 Cja(fel <br /> OWNER NAME PRONE <br /> OWNERADDRESS AA)/A- CITY/STATUZIP <br /> CONTRACEOR J"'rrr✓�4r�A]J ,$(/ ( �PHONE <br /> J(e pO C-A�c.JW W <br /> CONTRACEORADDRES �� 1.L3e`©oN bn.`Jp::k CITY/STATE/ZIP 4 l�Z S CAF <br /> b-o <br /> LICENSE -02 ❑C-36 . OTHER NUMBER U4T ZZ, EXPIRATION DATE T <br /> WATERTABLEDEPFH: Io0 t ft GEOGRAPHICALINFORMATION: CDordlnene X Y <br /> ❑APER$7E$T(�S) �UMBER LAND USE APPLICATION H Z <br /> TYPE OF WORK: 18 NEW IrvETALLATION ❑ REPAIR/ADDtT10N ❑ ENCINEERDFSIGNED/ALTERNATIVE <br /> ❑ RU`EACEME 13DESTRUCION (� <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROF BED0.0pME: n�,�..���Y NUMBER OF EMPLOVEER: <br /> SEPTIC TANK TYPF/MFG ieD CAPACITY /�e� $91 0 OF COMPARTMENTS fX <br /> ❑ GREASE TRAP TYPE/MFG CAPACRY 861 ROF COMPARTMENTS <br /> BIBB❑ PKC TX PLANT DISEANCETO NEARP.ST: WELL R FOUNDATION 10 RT <br /> fl PROPEY LINE /O� R A^ <br /> ❑ LIFT STATION SIZE TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCIANIEDSV31'EM) <br /> ❑ LEACH LINES LEACHING CHAMBERS B of LINES _ LENGTH OF LINES So ft <br /> wp <br /> DISTANCHM NPARE6r WELL /,00' R FOUNDATION R PROPERTY LINE IOO� ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DUTANCETONHARESr WELL R FOUNDATION_ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft C) <br /> BrB DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH It <br /> DISTANCLTONEARESr WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ gISPOSAL PONDS WmTH R LENGTH ft DEPTH ft <br /> ��•/// D16TANCETOqN,IE�AR!EST WELL ft FOUNDATION ft PROPERYLIINN'E ft <br /> SEEPAGE PITS WIDTH fl LENGTH ft DEPTH 4l / ft <br /> DISTANCETONPAREET WELL ��0� R FOUNDATION ^J �T ft PROPERTYLME R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STA S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI 3 URADVA CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2N)953-7697 O <br /> SIGNED TITLE DATE <br /> 1A4, j <br /> `n <br /> rg <br /> O 1 <br /> II <br /> N'A ON EN AL EP H.I V/ <br /> PA E USEONLY <br /> Application Accepted Y 5-iq'o� Arn ��� EmployF,11p SAA <br /> Flnallter of nBy Dan 7�F�6.� ❑ SPECIAL/PERMIT-Appmve by y _ r <br /> Chander of So oDept of3 FD (' P{USum Soll Chmc4er.1�=2T� <br /> COMMENTS <br /> PESC Ra vN ec Amount Date Permitl InvAce9 Permit IM <br /> Code INPO B Cuh Remined ServfuR uerlp <br /> BBB <br /> 2 1 �7 1 <br /> 1222 /' /_-/�,�/ �1��/l� S.P�lLj51T��1.J( TER PERMIT <br />