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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 1 SMI JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 6130 E MAIN STREET-STOC1tTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ' P-i CITYIZIP W j <br /> `` in <br /> CROSS STREET eF�' _ APN ��(VAI 'f�_ _ PARCEL SIZE R <br /> j OWNER NAME__F-tA 10 Il SD L*,e--( .. PHONE <br /> OWNER ADDRESS CITYISTATEIZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRgss CITYISTATEIZIP <br /> i <br /> LICENSE KC-42 ❑C•36 OTHER NUMBER 66 5/9- EIS{RATiONDATE d7=41-l4. j <br /> I <br /> i <br /> WATER TABLE DEPTH: K GEOGRAPHICAL INFORMATION: Coordinates X Y f <br /> ❑ PERC TEST # BUILDING PERMIT# D USE APPLICATION# <br /> TYPE OF WORK. NEW INSTALLATION ❑ REPAIRIADomoN G ENGINEER DESIGNED IALTEITNATtVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Pd RESIDENCE 0 COMMERCIAL ❑ OTHER <br /> NUMBER OF LYING UNITS: J NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG CAPACITY <br /> Qdt #OF COMPARTMENTS�� <br /> O GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEMy W <br /> LEACH LINES AP LEACHING CHAMBERS 744 OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL _. /SOS ft FOUNDATION_ Z&Q ft PRDPERTYLINE_ J(I.S y ft y• <br /> 0 FILTER BED Ill It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> 0 MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCETONEAREST WELL h FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH K LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTYUNE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY UNE <br /> GF' SEEPAGE PITS NuwBER--_ wo-rN `I ft OEM. It. <br /> t ~ DISTANCE TO NEAREST WELL—ii ft FOUNDATION AL ft. PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, t <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> i SIGNED TITLE_�gp1. DATE <br /> I <br /> . p,L <br /> _J <br /> 14 <br /> i <br /> 1 a <br /> R <br /> .� <br /> DEPARTMENT UAE LY <br /> Application Auepta Date 08 Area Employee ID# Sg'EBF 4 <br /> Final Inspection B Date ! ❑ SPECIAL PERMIT-Approved by <br /> Character of Soli to Pith of 3 Ft: Pfusump Soil Character: <br /> COMMENTS OL4 ­a`l Of– <br /> ,�-Ecaa� ' <br /> PE SC 1 Received Amount Data Permit/ <br /> Code INFO B s emllted Service Ra oast# Invoice# Permit IDS <br /> 42-(3 Il SDI a,� <br /> 97-01 CN5RE W <br /> I 1Df41D7 �._-_,_, ASTEWAT6RTRTMNTSYSTEMPERMIT <br />