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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN CouNTY EHv1RoN ••ENTAL HEALTH DEPARntENT 600 E MAIN STRUT -STOCKlON CA 95202·(209)468-3420 <br />NON-REFUNDABLE PERMIT CAlL 12091953-7697 FOR INSPECnONS .EX.PIRES 1 YEAR FROM DATE ISSUED?"'9'-/~/r//,t"'.••-rJoaADDRESS ClTY/ZIp ~ <br />CROSS STREET ~,.~APN o tff£VJ()QO I PARCEL SIZE /·5 <br />ONwER NAME J("di PHONE 9..1/-BZ'1e <br />OWNER ADoMss CITY/STATEIZIP <br />CoIiTRACTOR 6d4uA PHONE 931--/B9'f< <br />CONTRACTOR ADDRESS /oz:Z-7 EAtcyU CITY/STATI!iZ.w>-'~?ri i>V4~ <br />LIcENSE AC-42 QC-36 OTHER e!NUMBER 8$7.<203 ExPIRATlON DATE <br />WATER TABU:DEPTH:ft GEOGRAPHICAL INFOIIIIIATlON:Coordinates X y <br />~D~;.P~ER~C;,TE~S~T~'~~~~~~I ~B=U~IL=D=IN=G~P~E=R~M~IT~#~~~~~====~lAN===D~U=S=E~AP~P~L~~~A~n~O~N~#~~~~~~~ <br />TYPE OF WORK:a NEWINSTALLATlON a ENCINEERDESIGNED/ALTERNAT1VE <br />a REpLACE ••ENT o OTHER _ <br />NUMBER OF E ••PLOYEES: <br />DESTRUCTION <br />INSTALLAnON WILL SERVE:0 ,RESIDENCE <br />NUMBER OF LIVING UNIT1I: <br />o CO ••••ERCIAL <br />NU ••BER OF BEDRoo ••S: <br />[]SEPnCTANK T'vPEIMFG t~l.shr-_ <br />[]GREASE TRAP T'vPEIMFG ~..L____:_---- <br />DISTANCE TO NEAREST:WELL NA- <br />gal <br />gal <br />#OF COMPARTMENTS _ <br />#OF COMPARTMENTS _ <br />CAPACITY _ <br />CAPACrTY _ <br />c LlFTSTATION <br />It FOUNDATION______ft PROPERTY LINE fI <br />SIZE TYPE OF PUMP ,0 PKG 1)(PLANT 0 SAND OU.SEPARATOR (ENCLOSED SYSTEM) <br />~LEACH LINES o LEACHING CHAMBERS #OFUNES ~LENGTH OF LINES 7"0)'ft l\'l <br />DISTANC~TO NEAREST WELL./l~ft FOUNDATION /0/fI PROPERTY LINE (1'/ft <br />c FILTER BED WIDTH It LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WelL It FOUNDATION ft PROPERTY LINE It '$c MOUNDED WIDTH It LENGTH fI DEPTH ft <br />DISTANCE TO NEAREST WELL fI FOUNDATION It PROPERTY UNE It <br />[]SUMPS WIOTH It LENGTH It DEPTH It <br />DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br />[]DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WElL It FOUNDATION It PROPERTY LINE ft <br />~sz;.", <br />ft DEPTH -z,s:.J fISEEPAGEPITSNUMBER <br />DISTANCE TO NEAREST WElL fI FOUNDATION ,/1)~ft PROPERTY LINE d It <br />I HEREBY CERTlFY THAT I HAVE PREPARED THIS APPUCATION ANO THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.d /'M~:.7 ADVANCE NOTICE REQUIRED FOR INSPECTIONS"PL£ASE CAlL (209)953-7897 <br />SIGNED /....,~../"'"TITLE cE6 DATEY/3o/~r <br />1/".- <br />'4;/111'b( <br />~"'1.>,.,,·, <br />1"'7 .>4- <br />1'-"r<&..~'-:.~.,,, <br />l-I--,~,---.:-. <br />I--·r,.1\:1t ,1\Jll~v ~ilil "II.c:I~~V---",. <br />V --I Jl:J-rl:J n '111I,"'"--i--...-1--roc"r <, <br />..--r--............ <br />/~DEPARTMENTUS1·0N~1~~ <br />AppllcatlonAeeepted ~Date ":<.(~,~c51 Area Employee I ~qtI <br />Flnalln.pection8/.H~.t!',77~t'J/~"1fi!)Date ¥7/Jh9 0 SPECIAL PERMIT-Approved by <br />Character of Soli to D4~of 3 FI:f'~PltlSump Soli Character: <br />COMMENTS f>JI :r.I.h-r '-"~.100 U 'l<;>i 50 I "'-..•.../ <br />r <br />PE SC Received -ChedcJII :J Amount Date Permit!Invoice #ParmltlD#Code INFO By l:'aill Remitted 5efvlce Request' <br />Ith.JO lie;-~\,~'21Y ?_..:b_O ".)h611'i S~5t.,PK'S <br />42~1 <br />1014107 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMrr