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-^--'---------------- --------- <br /> w` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> . <br /> SAN JOAQvINCOUNTY ENVIRONMENTAL x,ALT.m,^"'m,p. `mmE.xAZcon,/wENv aTOxvTOwo«smo 'pomeo-342v <br /> NON-REFUNDABLE PERMIT CALL(209).953-7697 FOR INSPECTIONS ExPIRES 1 YEAR FROM DATE ISSUED <br /> ." Jos ADDRESS 1TY/ZfP _5 <br /> CROSSSTREET __14�_ APN__,MAl_Pi_1L PARCEL SIZE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR VA: PHONE. st -,184 <br /> CONTRACTOR ADDRESS <br /> LICENSE DMC-42 L1IjC-36 OTHER— NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: o GEOGRAPHICAL INFORMATION! Coordinates x ,�__� <br /> D PERC TEST #_ I F��DING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I.; NEW INSTALLATION t�- RrPAiR/ADDITION 11 ENGINEER DESIGNED/ALTEnNAnvE <br /> '' n,m^omam I OUT-OF-SERVICE SEPTIC SYSTEM n ocmnvvnow <br /> INSTALLATION WILL SERVE: k��SIOENCE Ll COMMERCIAL D OTHER <br /> NUM13ER OF LIVING UNITS:--A-- NUMBEROF BEDROOMS.'- —3 -_ NUMBER OF EMPLOYEES:-- <br /> (3 SEPTIC TANK ,,~mw,e _ u^p^mryy°/ #mCOMPARTMENTS 13 oncxacrnA, rvpEfm,o o^mu/n/ ou/ vupnvm,^n`wcNTS______'_ <br /> DISTANCE rnNEAREST: waLit rovwmnmwit PROPERTY LINE o <br /> U uprarxnow SIZE TYPE orpomp______o pxanxPLANT o SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> o LEACH LINES / usxcxwmuoumoenm______-'-'-__-_ "npuwm_____ Lcmar*orLINEs it <br /> . <br /> DISTANCE To' NEAREST <br /> ---'wsu it / FOUNDATION it PROPERTY LINE it <br /> m/�''osneen - ' x ' DEPT it <br /> o/ym*m_Tvwc^xm, WELV it FOUNDATION PROPERTY LINE : <br /> J movmoco w."= n `+_rwm` _ it oeprx n <br /> DISTANCE mNEAREST Weu___-.___// FOUNDATION-it PROPERTY LINE n <br /> L1 sumps */mn it Lcwu`w ________.o DEPTH it <br /> DISTANCE mNEAREST woL_______. It FOUNDATION___n PROPERTY UNE it <br /> * DISPOSAL PONDS WIDTH it LENGTH it DEPTH it <br /> DISTANCE rvNEAREST wcu__--'-_--� o FOUNDATION it PROPERTY LINE o <br /> o osspxasp/no wmmo.___________ ��� ___ o,pr^ it <br /> DISTANCE,nNEAREST it FOUNDATION it PROPERTY uws_____-____x <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION 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 404ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGHED TITLE CC-+ DATE <br /> V41 VjT �L� <br /> DEPA TMENT USE ONLY <br /> Da Employee ID# <br /> Final Inspection 8 ate. f S4�alT-Approved by <br /> Character of SoA15' th of 3 Ft:_ Fvs-��m�?p Soil Characte <br /> COMMENTS <br /> PE *It.�10 0 <br /> SC — Received (CheckU7 PermitY/ Invoice If Permit 100 <br /> Date Service Re uest# <br /> If <br /> mm ONSITE WASTEWATER nnMwrSYSTEM PERMIT <br /> ^°°'° <br />