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� I <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ' <br /> SAN JOAQUIN COUNTYEWIRDNMErl HEALTH DEPARTMENT 1868 E HAZFITON AVENUE-SydCRTON CA 88206-(208)46845620 <br /> NON-REFUNDABLE PERMIT yt� CALL 209 953-7697FOR INSPECPONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOE Actual �``^IIyE��1L� 'E/ P <br /> CRoss STREETIV 0+Oc6 Ln,ne. APN o 3-7/L�30 - 1�.®1 AI f�BL SRE��_•�MJS— e ' <br /> I III <br /> OWNER NAME <br /> IGlr\ iarLAT�'S yAyy�E1_ d ��(f/r(].\01�4$. 1,..LON�Ha �1� �• ���•0441 <br /> OWNER AIIOREBS I a 4 3 O G• !"A \k ( SOA •�� . CITY/STATJZIP 1 1 y_Q_S a9 o <br /> aVl -' -I <br /> C.N.COPH <br /> CONTRACTOR•- - CITISTATEMP .l 'bC& <br /> g5(a3a <br /> I <br /> LICENSE C42 ❑_C-36 OTHER NUMBER EXPIRATION DATE <br /> ^ \ 'WATER TABLE DEPTH: �IOY� it GEOOf1APMGALINPORMATON: Coordinates X Y <br /> D PERO TEST IS BUILOINGPERMITd LAND USE APPLICATIONS <br /> TY- PFE GRIT' �K'. j D REPNRI OITION J ENGINEERO IGNEp 1Al NAIVE <br /> D REPLACEMENT 3 OU-0FSERACESEPTLSYSTEM 7 DERTRUCTON ' <br /> INSTALLATIDNWILLSERVE: D RESIDENCE ❑ CG AERCUL D OTHER <br /> NUMBER OFLMXO UN.! NUMBEROFBEDRO011s: NUMBEROFEMPLOYEE3: <br /> ❑ SEPnCTANK TYPEIMFG CAPACITY gal #OPCOMwuTTAenm <br /> ❑ GREASETRAP TYPE/MFG CAPACGy Bal #oFCOWARTMEA ' <br /> DISTANCETO NEAREST: WELL It FOUNDATION R PROPERTY LINE A <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SANDOILSEPARATOR(ENCLOSEOSYSTEM) <br /> ❑ LEACH LINES D LEACHING CHAMBERS #OFUIJES LENGTHOFLINES it ' <br /> DISTANCE TO NEAREST WELL R FIXMOATWN R PROPERTYUNE R <br /> ❑ FILTERSED WIDTH (1 LeNGTI R DEPTH D <br /> DISTANcEWNEAREST WELL R FOUNDATION R PROPETurr UNE R <br /> ❑ MOUNDED WIRTx R LENGTH R OEM A <br /> DISTANCETO NEAREST ALL R FOUNDATION A PRGPETYUNE IH ' <br /> ❑ SUMPS WDTx N LENraRi ft DEPD, A <br /> DISTANCE W NEAREST WELL fl FOUNDATION R PROPERTYUME R <br /> ❑ DISPOSALPONDS Wmrx R LENGTH R DEPTH_R <br /> DISTANCETONEAREST ,,l R FOUNDATION fl PRdPERTYLINE R ' <br /> ❑ SEEPAGE PITS NUNSER WIATH A DEPm R <br /> DISTPNGETGNEARERT WELL # FOUNDATION R PROPERTY LINE _ It <br /> (HEREBY CERTIFY THAT I HAVE PREP0.HE0THIS APPLICATION AND THE WORKWILLBE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCE$ <br /> ' <br /> STATE LAWSANO RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. ' <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76�9�TT7/ <br /> SIGNED C A� TITLE C<�c T DATE 7 'LXGJ <br /> Pqy. �� <br /> AY 2 6 2017'OAQ ' <br /> lRONMEOU/I <br /> DEpgR MEMT ' <br /> P RIME T Yt <br /> Application Accepted Data Area • Employaelo8_L1';c) <br /> Final Inspection By Dale ❑ SPECIAL PERMIT-APPmSdby ' <br /> Character of Sall to Depth of 3 FC PRISump Soil Character. <br /> COMMENTS <br /> PE SC Rec.w.d Amount Date Pecodu Invoice# Permit HC# ' <br /> Code IIIII B Cash Remitted Service Re oast# <br /> 7/ 11Sq l_ <br /> ONSITEWh6TEWATER TRTI SYSTEM PERMIT <br /> •a-0I ' <br /> 4124 2 <br />