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ONSITE WASTEWATER TREATMENT SYSTEM PERMI I e-520,2-237 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-VPC-STOCKTOK CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT C 309 953-76197 FOR INSPECTIONS E PIRES 1 YEAR PROM DATE ISSUED <br /> JOBADDRESS �N CI'N/ZIl, /r <br /> CRMSTREET ^ ` APN�63;3o-3Io PARCELSIEE 2 4c- O <br /> / '•� 'G/G O <br /> OWNER NAME i /PHONE _rI©TQC/OWNERADDREss -O C �0Z CITYISTATEIZAP 4DC`BKA `ie-n9�{ <br /> CONTMCFOR N l ' PHONE <br /> COHTMCI'ORADORF89 CITY/STATFJZIP <br /> i LICENSE 3iV42 0C-36 OTHER NUMBER EKPIRATIONDATE <br /> WATER TABLE DEPTH: fl GEOGMPHICALINFORMATION: COprdI..t. X Y <br /> ❑ PERCTEST p BUILDING PERMIT# - Z LAND USE APPLICATION# <br /> YP <br /> i TEOF WORK: NEWINSTALIHON ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: IOENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMB ER OP LIVING DNEIS: NUMMB)EROFBBEDROOMS: n NUMBBROFEMPLOVEES: <br /> i M—SEPTICTANK TVPEJMFG Ber� CAPACITY IfUo� E01 kOF COMPARTMENTS `I <br /> ❑ GREASE TRAP TYPUMFO CAPACITY RBI #OFCOMPARTMENTST <br /> C3PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE 3 to R <br /> i ❑I LIT STATION SEES TYPE OF Pump ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> & <br /> y� LEACH LINES LEACHING CHAMBERS � 60 <br /> V.< it <br /> kOF LMES LENGTH OF LINFS �J R <br /> DISTANCETONLAREET WELL ft FOUNDATION�it PROPERTY LINE- �I TR <br /> ' ❑ FILTER BED WIDTH R LENGTH R DEPTH R <br /> DISTANCETONEARPAT WELL it FOUNDATION ft PRWERTYLNE R <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATpN R PROPERTYLNE R <br /> ❑ SUMPS WUmH fl LENGTH R DEPTH R <br /> i DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LIKE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH it <br /> DISTANCETONEAREST <br /> WELL fl FOUNDATION ft PROPERTYY.LINE <br /> ft <br /> ❑C SEEPAGE PITS NUMBER_ WmTx •� -ft DEPTH n41 R <br /> i DISTANCE TO NEAREST WELL R FOUNDATION SO R PROPERTY LINE C fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPMCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM?•HOUR ADVANCE NOTICE REQUIRED FOR INSPECT NS-PLEASE CALL(2 091 953-7697 <br /> 1 SIGNED S Iw ft TITLE DATE 05— <br /> LLLLi <br /> 1 <br /> i <br /> i <br /> q UI G <br /> ii n ' DEPARTME_NTUSE NL <br /> Applla[0AaepDMD AraTT <br /> EmPloytt ID <br /> CharReterDfSolltDDe1Df3 Pit/Sump Soil Character: <br /> IFpecUonB DID, � [3 SPECIAL PEERRMIT-ApP..d by <br /> COMMENTS <br /> y <br /> a _F <br /> PE SC ..I. Ch A..M Drt Pe 0, IDYDI-# <br /> Co" Dp <br /> IXTOB Cub Remitted Service Dat# <br /> 1 1 E2 <br /> i 4b034101 ONSTITWASTEWATERPERMIT <br /> IMM003 <br />