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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 F.WEBER AVE-3-FL.STOCKToN CA.95202 -(209)468-3420 � <br /> NON-REFUNDABLE PERMIT CALL.(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> {,. t -�-�--- <br /> JOB ADDRESS -�>•�iJ CrFY/ZIP_ f 1F�7,7F,� L <br /> tI� h <br /> CROSS STREET t> <br /> _ APN PARCELSIM, _ p <br /> OWVERNAmr LF4,y .1k, �(�[ _ PHONEA&7 lJV¢ •$ ci C <br /> OWNER ADDNES.G 9 [/ 4/l�Y CITY/STAT}JZIP <br /> ! CUNI'RACTORl C. P110NE <br /> (:VNIaA�TGR ADDRF.Sfi CITYISTA'fFfZIP <br /> LICENSB C-42 U(.-36 OTHER NUMBER EXPIRATIONDATF. --� <br /> WATERT.N EDEPTH: f1 CEOCRApHTCALINPORMATION: Coordinates X }' <br /> ❑ PERC'FEST CC i BUILDINCPERMIT# PYEEIL LAND USE APPLICATION# <br /> TYPE OF WORK:M .N'LW INSTALLATION ❑ RP.PAIR)ADDrr1UN L7 F.Nf,INF.BR D!'•il1:NED/A1.TCRNA'r'IYL'. + <br /> U REPLACEMENT _ ❑ DESTRUCTION �y _ <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL yaa.OTRF.R J <br /> NUMBER OF I.IVING UNITS: NU MOER OF BEDROOMS:_ NUNaEROFEMPLOYEES: ^] <br /> J SEPTIC K,TANTYPF/MFGr''?,_(,_ <br /> _ Y "}_L _ CAPAC:ITY y/'{�/� gol #UFCOMPARTMENTS C <br /> L7 CREASE TRAP TYPE1MrG_ 1 - _ CAPACIFY_ _^ gal 4 Of COMPARTMENTS <br /> CJ PKI;TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION A PROPERTY LINE ft <br /> LI LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCL.OSEu SYsrEM) <br /> ❑ LEACIi LINES ❑ LEACHING CJIAMRERS q OF LiNPS _ LENGTH OF LJNSS ft <br /> DISTANCE To NEAREST WELL �LLL.L—,-it FOUNDATION ft PROPERTY LINE _ ft <br /> ❑ FILTER RED WIDTH ft LENGT{ ft DEPTH fl <br /> DISTANCET0,NEAREST WELL it FOUNDATION ft PROPERTY LINE ft Il- <br /> MOUNDED WIDTH ft LT;NGntft DEPTH fl <br /> ._....._..... <br /> _ - -- <br /> DIsrA:NCK'to NEAREST WELL R FOUNDATION ft PROPP.RTY LINE _ t <br /> ❑ SUMPS WIDTH —ft LENGTH _ - ft DEPTH __. R r <br /> DIST.ANCETONEARESr WELL ft FOUNDATION ft PROPERTY LINE ti - <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH_ ft DEPTH <br /> DISTANCETONir.ARESr WELL ..._ft FOUNDATION ft PROPERTY LINE �R <br /> ❑ SEEPACE PETS NusrBER WttrrN ft DEPTH ft <br /> DISTANCE 3.0 NEAREST WELL _ft rovNDATIO\ ,ft PROPr.R'TY LINE R <br /> F� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY U <br /> ORDINANCES,STATE LAWS AND RUL.ES AND RMA:U LATIONS OP SAN JOAQjA K COUNTY. <br /> ,MMIItY_M_UM 2 OUR ADV CF.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)453.7697 <br /> tiICNED sF <br /> :Z <br /> TITLE DATE U- <br /> r` <br /> 17 <br /> / <br /> )L NTf <br /> _ I <br /> t <br /> 1 <br /> FNVIRO E T L <br /> DEPARTMENT U E ONLY <br /> Application Accepted ByeGI- Date (t �� U C Arca .�1 F.mpioycc(Dlf <br /> Finn!Inspection By t f_ 2 -_ Date 8 v ❑ $PECIAL PERMf"C-Approved'oy <br /> Character of Soil to De of 3 Ft: Pit/Sump Soil Character: <br /> COMMLN'fS /A-,FCe' i :f oo+rCr+f'i1 At `i -Z`ir �C j _L..t•� MuS7-tai 4 L n5 <br /> PE SC Received hcrk#1 Amount Dare Invoire# Permit IDC( �! <br /> Code IMS)) B as Rcrnitted Service uos1B t4r� <br /> 42 it 117 32a.T.f, X01 0 <br /> 42-02401 ONSITE WASTEWATER PERMIT <br /> 12l22R003 <br />