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ONSITE WASTEWATER TREATMF SYSTEM PE �7J <br /> SAN J ulx COl�NVIRONMENTAL HEALTH DEPARTMENT WEBER AVE-3-FL-9TOCKTOtCA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT �j C LL(209)953-7697 FOR INSPECTIONS EJXPIRES 1 YEAR FROM DATE ISSUED <br /> JoB ADDRESS O L✓ .� ��' '�-/ r CITY/ZIP L <br /> CR04SSTREFT APN Oc {-'ge-- G5 PARCELSIZE /7 -C V <br /> e <br /> OWNER NAME --j PHONE,// G y <br /> ` OW'NERADDRESS M�r}✓n P✓/(��0y- [`s.— CITYISTATE/ZIP <br /> CONTRACTOR r• �V'1� SL✓J - PHONE - - <br /> CONTRACTOR ADDRESS CITYISTATEIZIP / <br /> LICENSE -42 ❑C-36 OTHER NUMBER EXPIRATION DATE Inv- C� <br /> WATER TABU:DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST a BUILDING PERMIT# '[ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION U REPAIRIADDITION Q ENGINEERDESICNEDIALTERNATIVE <br /> ❑ REPLACEMENT 0 DESTRUCTION -' <br /> INSTALLATION WILL SERVE: 2KRLSIDENCE ❑ COMMERCIAL ❑ OTHER <br /> ,b NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - NUMBER OF EMPLOYEES: <br /> ILIA SEPTIC TANK TYPE/MF c/G�L+�+ r CAPACITY C.f Gf gal H OF COMPARTMENTS ___._ <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY 2 gal 0 OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION r�© ft PROPERTY LINE -- 4 S R <br /> © LIFT STATION SIZE TYPE OF PUMP © SAND OIL SEPARATOR(ENCLOSED S,YrS�TEM) <br /> j� LEACH LINES d LEACHING CHAMBERS 6OF LINES eD2— LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL SID tR FOUNDATION ft PROPERTY LINE J G✓ ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> D MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE-YO NEAREST WELL R FOUNDATION ft PROPERTY LINE fl <br /> d SUMPS WIDTH ft LENGTH ft DLPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TO NEA SC WELI, ft FOUNDATION fl PROPERTY.LIIN-E— ft <br /> SEEPAGE PITS NUMBER WtDTx S ft DEPTH�5 S5 .- R <br /> - DISTANCE To NEAREST WELL R FOUNDATION R PROPERTY LINE &Q .- .ft <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 /> P Ml ' UM 2 )HOUR ADVANCE <br /> NOTICE REQUIREID FOR INSPECT NS-PLEASE CALL 1209)953-7697 <br /> SIGNED <br /> f�/O- ,••' TITLE DATE <br /> L <br /> a <br /> I <br /> i <br /> hk <br /> r <br /> a <br /> � a <br /> DEPARTMENT UF ON Y <br /> Application Accept - `" Date 7 GArca Employee IDti <br /> Final Inspection y Date G2`JI] SPECIAL PERMIT-Ap roved by <br /> Character of Soil th of 3 1: Pit/Sump Soil Character: <br /> __COMMENTS i'Lla t �T e-F <br /> PE SC Recelwd ec1*1 Amount ate Permit/ Invoice H Permit ID# <br /> Code INFO B ash Remitted Service Re uest t! <br /> -2_.il W7 <br /> 42-02,091 ONSITE WASTEWATER PERMIT <br /> -12122/2003 <br />