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�-A okc)c!'L o / <br /> ONSITE WAEWATER TREATMENT SY `:M PERM <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3KO FL-STOCK N Q468-3420 <br /> NON-REFUNDABLE PERMIT CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATEJSSUED <br /> Joa ADDRESS C7 `it C3 p] i C Tv1ZIP <br /> CROSS STREET ` .l 1 y APN -1 ( PARCEL SIZE 7 0 " '3 O <br /> `� <br /> � PHONE ✓— <br /> OWNER NAME <br /> OWNER ADDRESS 1T(Y/I�ST,ATEIZ[P <br /> CONTRACTOR /�' V ' J �V PHONE -6 X4.1 <br /> I� CONTRACTOR ADDRESS b0i CITYISTATElZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # gUILDINC PERMIT# C3 7-5 E APPLICATION# <br /> LAND US <br /> TYPE OF WORK: X NEW INSTALLATION -EI REPAIR/ADDITION ❑ ENGINEER DESIGNED)ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑IN <br /> COMMERCIAL ❑ OT'HER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROF EMPLOYEES: <br /> 2 SEPTIC TANK TYPEIMFG CAPACITY g #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> �+ ' DISTANCETONEA`RFSST WELL ft FOUNDATION ft PROPERTYLINE ft v <br /> FILTER BED WIDTH � Ct t N TH ft DEPTH ft <br /> 7AJ�t� 4tSTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> El MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> 1 DISTANCE TO NEAREST• WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O DINANCES,STATE LAWS AND RULES AND REGULATIONS 9F SAN JOAQUIN COUNTY. <br /> M IMU A 'CE NOTICE REQUIRED OR I . F -S P (209)953-7697DATE <br /> SIGNED <br /> Lf <br /> x <br /> E <br /> {{W FH DEIATMENT <br /> J � <br /> '. <br /> DEPARTMENT U E O LY <br /> Application Accepted By ��� Date 3 7- �� Area � A <br /> Employee ID# 0 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Suil to th of 3 Ft: Pith ump Soil Character: <br /> ^ COMMENTS OC O L-CP7--o F 2eGa" Ft C7-I<_/L/�," <br /> k V , <br /> PE SC Received Check#/ Amount Date PermitT Invoice# Permit IDN <br /> Code INFO By ash Remitted Service Request# <br /> 42 .13 11-7 t6 . '#d-09-1'1 �S4•""D <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />