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� .. . <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAWIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT EOD E MAIN STREET-STOORTON CA 95202,(209)CBS-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREss % KD E TnPb t I CIT/r�myP�(N�^"`Yo �S 22 [a <br /> CROSS STREET `'\G\-IIQ R[1 <br /> All :/%JV `��� PARCELSQE 2�J <br /> OY RNAME \`ENI l' F(AT'-( PI <br /> OWNERADORESS EAnr. A'�, CTTYISTATErZP <br /> CalTwAcTDR \4Lkj WnSY CSF.G.K Nota �tiL PHONE 03'11"12, G <br /> CONTRACTORADDRESS \\16 \1LVEf 'pO INYE: OQ�p —CITY/STATE" LJe*'X f/c �T52`7�1 <br /> LICENSE '�1C42 QC-36 OTHER, A NUMBER OSI.IS-7 EXNMTgNDATE 2010 <br /> WATER TABLE DEPTH: R GEOaRAPHICAt INFORMATION: Coprdinatp X Y n <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORIC O NEW INSTALLAl10N REPJNRlAOp U ENWNEER DESIGNED/ALTERNATNE rTl <br /> ❑ REPLACEMENT ❑ DESTRUGTa1 I <br /> INSTALLATION WILL SERVE: 1 ❑ REMOEHCE COMMERCIAL ❑ -OTHER <br /> NIIM9EN OF LMNG UNITS: _ NIMSdt OF SEDROONS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFGCAPACITY 981 #OFCOMPARTMENTS <br /> 4a/GREASETRAP TYPFJMFG 12.eC3 Sw bE1 CAPACITY L2a0 981 #OFCOMPARTMENTS L <br /> DLSTANCSTONEAREST: WELL taS b R FOUNMTRXI SIT- ft PROPERTYLINE 100 R <br /> C1 LIFT STATION SUP TYPE OF PIMP O PKGTXPLAMT O SANDOIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACHLINES ❑ LEACHINGCHAMBERS #OFLINES LENGTHOFUNES ft <br /> DISTANCE TO NEAREST WELL ft FOUHOATKIN R PROPERTY LINE It <br /> ❑ FILTER BED WOTH R LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It <br /> ❑ MOUNDED WIDTH R LBNGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNaATON R PROPERTY LINE R <br /> ❑ SUMPS W..* ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH R DEPT fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE fl <br /> O SEEPAGE PITS NUMBER " WIDTH ft DEPTH fl <br /> DMTAHOE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SMI JOAQUIN COUNTY ORDINANCES, <br /> STATE LA 'D RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> OUR ADVANCE NOTICE REQUIRED FOR INSPEC <br /> T <br /> IONS-PLEASE CALL(209)953-7597 <br /> 51 TITLE DATE -Z� <br /> I <br /> ) <br /> 1 <br /> I <br /> I <br /> 1 I <br /> I UI <br /> E <br /> DEPARTMEN ON <br /> Applieall Accepted Date Mea Emplo;ibe-IDN <br /> FUM,im mue Date /af/i F ❑ SPECIAL PERMIT-Approved DY <br /> CharECEro}Soll Dept 3Ft' PIUSump SUIT Charse)sr. <br /> COMMENTS <br /> PE Sc R.Cal"d AGlourd Permit! 1.4"# Ill <br /> I Code INTO flied I Servio,Regiaest# <br /> S tJ- <br /> II <br /> l <br /> ONSITE WASTEWATER TRTMNT SYSTEM JMM <br /> 10447 <br />