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iv3� f�J S.641 <br /> p ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAI}JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304EWEBERAVE-3°FL-STOCKTONCA95202 - (209)16&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRFss I CmILR Lo i-, CLE-2-42 <br /> CROSS STREET F C_-1T ,�_. APN nsr 11i — 4 PARCELSIEE S.�� <br /> I OWNER NAME FTG ! ftx ,-1I'ft 14 PHONE <br /> -a <br /> OWNER ADDRG55 I Z H� �G/7 j ? CIn/BTATEITJP��j <br /> t` <br /> CONTRACTOR PHONE <br /> 1 COMWCFORADDIIISC � CRY/STATVLIP <br /> ( <br /> LICLN6E ❑CJ2 ❑C-36 OTHER NUMBER ��JnEgINATIONDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORNATION: CODTdln&M XPA+t7J�Y'. 4i V I <br /> PERC TEST N BUILDING PERMIT# LAND USEAPPLICATION# 9vj 091 <br /> TYPE OF WORK: O NEWINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDGSIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DEBIRomoN <br /> INSTALLATION WILL SERVE: ElRESIUENCE ❑ COMMEROAL (] OTHER <br /> I, NUMBER OF LIVING UNITS: NUMBEROFBEOROOMS: - NUMBEROFENPWVE": <br /> ly ❑ SEPTIC TANK TYPE/MFa CAPACrtY <br /> pI #Oi COMPARTMENTS <br /> T1[^, ❑ GREASETRAP TYPVMFG CAPACITY ®I #OFCOMPARTMENTS <br /> ❑ PKG TXPWNT DISTANCE TO NCAREST: WELL It FOUNDATION fl PROPERTY LINE <br /> ❑ LIFT STATION SIEE TYPE OE PUMP ❑ SAND OIL SEPARATOR(ENCLosED SYSTEM) <br /> e <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS _ NOFLINEs LEN MLINES R <br /> DISTANCETONEARFSE WELL - ft FOUNDATION ft PROPERTY LME ft <br /> ❑ FILTER BED WMEH R LENGTH R DEPTH It <br /> DIBrANCETONEAREsr WELL R FOUNDATION R PROPERW LINE ft <br /> ❑ MOUNDED WIOTN - ft LENGHI ft DEPTH R <br /> DISTANCE TO NEARm WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS W. fl LENGTH ft UERN ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISAL PONDS SPOOW. LENGTH NGTH ft OEM ft <br /> 4 DI$NCE ONGRf$T <br /> WELL A FOUNDATION a PROPERTY LINE R <br /> 1 ❑ SEEPAGE PITS NUMBER WIOTN ft DEM ft <br /> DISTANCETONFAIHST WELL R FOUNDATION ft NIMERTY LME ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI UM Td HOUR ADVANCE NOTICE REQUIRED FORTNSPECTIONS-PLEASE CALL(209)953-7697 <br /> EIGNED_ F�Vl'1 LV TITLE_' ep DATE 7/6S/Ol <br /> 13 <br /> n3� <br /> I <br /> I <br /> EJ . <br /> ApWlealbn A13cC9:lvI R Date Ara EmPloya IDN- r <br /> ".I Inapectixn By ~ DO,� SPECIAL PERMIT-Approved by <br /> Chmclerof Soll To Dept' of3 FI: PiUSump Soil L-hander: <br /> COMMENTS AlrAorf� 440e. <br /> ,4LIrGo'?va*6CU G T3eqw-HJ zo aKn4 .ft sncs/7•f7Ta7.4r�ii.�/w I <br /> PE SCRadved F Amoum DRIB Permitl Involtt0 PerMIe ID# <br /> Code Inco a Cash Remilt Servi.R unl# <br /> 7.2y �1v 13 Zi �3 0 <br /> ONSITE WASTEWATER MAMR T <br /> ILl]lIBBI ' <br />