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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �acxt <br /> SAN JOAQUIN COUNTYENVIRONMENTAL.HEALTH DEPARTMENT 304 E WEBER AVE-3`"FL-cTrocx O).CA 95202 - (209)468-3420 <br /> NON-RFFUNDAHLE PERMIT ty� ,` CALL 209 953-7697 FOR INSPF,CTION.S EEX-PIIRE�S 11 YEAR FR/}OM DATE ISSUED <br /> JOR ADDRPKS el'5../,.�,�P�ft��ZOr" �cI1E a y �r CITY/LIP <br /> CROSS STREET , ` • cV"TA'tq�i p��T o/01: APN ORYG-?1W-(Z PARCFLSVE Z-O 16'4-f <br /> OWNP.RNAME TiI K-FcI} fVl _ PRONF___- �n <br /> OWNERADDR--M L_. - CFIY/STATE21P-`_^/_ <br /> COhNTRACTOR c,PTc+�^ �G `��•I N.0 -�`�� PIIUVE ter/I -361-Z-S,S-L. <br /> (`O`rrRACPOR ADORESS��jrl 1J p,c0 C1TY/STAwZIP'STOC-'h/ <br /> LICENSE i2 ❑C-36 OTHER NUMBER EXPIRATION DATE_7 Orj <br /> WATER TASL¢DEPTH: it GEowLAPHICAL INFORMATION: CoardlOateS X Y <br /> ❑ PERC TEST # - I BUILDING PERMIT# LAND uSE ArruCATiov#__ <br /> TYPE OF WORK: Ilt NEW INSTALLATION O RTPAIR!ADDTTION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMT.NT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> NUMBFR OF LIYN61 wTs:_�r��s�� NUUMMVER OF BEDROOM$: �D NUMB ER OF EMPLOYEES: <br /> EI <br /> SEPTIC TANK TYPF.!M}O r1t'(il.R'yT I T R•L CAPACITY1 ice_ fal M OF COMPARTMENTS j <br /> ❑ GREASE TRAP TYPE!MFqCAPACITY_ gal #OF COMPARTMENTS <br /> ZI Z5 <br /> PKC 7-X PLANT DISTANCE TO NEAREST: WELL�_��{- ft FOUNDATION_.1�__. fl PROPER'fV LUNEft <br /> ❑ LIFT STATION Sur TYPEffOFFtPUMP ❑ SAND OIL SEPARATOR(ENCI-OsEDSYSTEM) <br /> U LEACH LINES %-LEACHINCCHAMBERS7.0 h1 2 k ?-Q #OFLINE.st.eNurNofLwEs__645I __.f1 <br /> DISTANCE TO NEAREST WELL IOOt R FOUNDATION ft PROPERTY LINE <br /> D FILTER BED WIDTH_ R LFNGTHR DEPTH <br /> DISTANCE TO NLARBST WELL_ R FOUNDATION R PROPERTY LINE 4'4-R <br /> O MOUNDED w/nrR _ft LEr+OTH_4 ft DEPTH R <br /> D/STA.NCETONEARESP WELL R FOUNDATION R PROPERTY LME ft <br /> O SUMPS WIDTH R LENGTH 11 DEPTH <br /> Dtsw4cr..TO NEAREST WELL _t) FOUNDATRSN R PROPERTY LINE <br /> U DISPOSAL.PONDS Wim R LENGIN fl Drn a <br /> DISTANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE <br /> 16 SEEPAGE PITS NUMBFR f/ WtM_ _( �F DEPTH ti <br /> T <br /> DISTANCE TO NE:ARFST WELL ISD +" R FUUNOATfON 100 + R PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED TH15 APPLICATION AND THE WORK WILL DE DONE IN ACCORDANCE KITH SAN JOAQUINCOUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY. <br /> MINIM jM 24 HOUR ADVANCE NOTICE.RF,QUIRF.D FOR INSPECTION&-PLEASE CALL(209)953-7647 <br /> TITLE__rjffV1--T�0-rZ- DATE fZ10-LLOA1 _ <br /> r <br /> it <br /> RE At <br /> r) <br /> 0 <br /> f <br /> I � <br /> rn A �< <br /> ( ME NT <br /> �1 <br /> o <br /> -p71 <br /> N <br /> tl <br /> DEPARTMENT IIS ONLY .� <br /> / cc <br /> C Application ArcclH, - ��� Date_ /_Z�2'Y L` Arm 2!� Employee IDN <br /> final Imlpceliun _ Dole ma ny' _ ❑ SPECIAL PERMIT-Apptoved by_ <br /> Character of S„flt a0 � Pit/Sump Noll Cha Wrier: <br /> COMMENTS /L Etc WT F t2t~�c�_A �• 7,�-� �� _F��j ,�xsS,•(� ,�-/— <br /> IPC 5C RenlYed Amount - ermll <br /> :ode two Cash Remitted Dar Service Re uest# voice# PermHITnI <br /> ( <br /> 117 4 <br /> 42A2-001 (NISITP.WASTEWATER PERMIT <br /> ' IbZ24fg1 <br />