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�o <br /> ONSITE WASTEWATF''`-�TREATMENT SYSTEM PERMIT <br /> SAN JOAQl'IN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AV'E-$"FL-$TOCKTONC <br /> NON-REFUNDABLE PERAIIT # 468-3420 <br /> CALL 209 953-7697 FOR IN'SPECTIO.NS' EXPIR ISSUED <br /> FROSS <br /> ESS �-� DL <br /> CITY/ZIP <br /> REET 3 y <br /> PARCELSIZE 337•RC!, p <br /> AME C <br /> r^� PHONE ai <br /> DDRESS 5006 cyt 1^ �' CITY/STATE(Z!P <br /> aszfS <br /> CONTRACTOR ILE <br /> � <br /> CONTRACTOR ADUNESS CITY)STATEIZIP <br /> PY <br /> LICENSE, ❑C-42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: II C6OGRAPHICALINFORMATION: Coordinates X <br /> ❑ PERC TEST # Y <br /> _ $UILDINCPERMIT# 'D S LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPmWADDITION Z) ENGINEERDESIGNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> P]NfST7ALLATIONWILLSER�VE: ❑ RESIDENCE. ❑ COMMERCIAL ❑ OTI{Ex <br /> NUMBER OF LIVING UNUMBER OF BEDROOMS: <br /> ` NUMBER OF EMPLOYEES; <br /> Xi'71� $EPTICTANK TYPEIMFG <br /> CAPACfTY gal #OF COMPARTMENTS Z' <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY <br /> gal 0 O COMPARTMENTS <br />! ❑ PKC TX PLANT DISTANCE,TO NEAREST; WELL A FOUNDATION <br /> f 11 PROPERTY LINE A <br /> ❑ LIFT STATION SIZE TYPE OF PUMP <br /> ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i 'Z4 LEACH LINES ❑ LEACHING CHAMBERS # ♦{ <br /> /N of LINES ! LENGTH OFLINES <br /> DISTANCETO NEAREST WELL_ ft FOUNDATION �!ld A PROPERTY LINE ) <br /> ❑ FILTER BED WIDTII ft LENGTH A DEPTH <br /> A <br /> DISTANCE 70 NEAREST WELL A FOUNDATION A PROPERTY LINE <br /> IJ MOUNDED WIDTH A <br /> A LENGTH A DEPTH ft <br /> DISTANCE TO NEAREST WELL A FOUNDATION A PROPERTY LINE A <br /> ❑ SUh1PS WIDTH B LENGTH A DEPTH <br /> A <br /> DISTANCE TO NEAREST WELLA FOUNDATION A PROPERTYLINE ft <br /> j <br /> i <br /> O DISPOSAL PONDS wIDTR ft LENGTH R DEPTH <br /> A <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH A DEPTH <br /> n <br /> DISFANCETO NEAREST WELL It FOUNDATION ft PROPERTY LINE A <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION 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 /> M! 'IA7UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)453-7697 <br /> Y SIGNED` TITLE � DATE p`CJ 6 <br /> d � I <br /> 4 <br /> 65' <br /> ar I <br /> p <br /> i <br /> T' I <br /> S O a' M <br /> ----------------- <br /> ------------- <br /> DEPARTMENT , OX--y, "lv' <br /> Application Ace ot�,v dmf Dale `/ 'Area Employee ib# 53 6 <br /> Final Inspecti n By nate_ �7/aG ❑ SPECIAL PERMIT-Appiove4'by <br /> Character of n Dept of 3 Ft: CX'.P,iNSump Soil Character: <br /> COMMENT D <br /> PE SC Received heck#! Amonnt Pe it/ <br /> Code INFO 8 ash Remitted Date Service Re ues[# Invoice# Permit ID# <br /> r t S <br /> 1 D6 ' oo - <br /> az-oz-uoI <br /> 121221?OW ONSITE WASTEWATER PERMIT I <br />