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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> A• SAN JOADUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER APE.3"FL.STOCKTON CA 96202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Joa AppRFAS- ./ <br /> M <br /> ^ C�/m�J�121P �9f mVtJO tM� -lam <br /> CROSS STREET /," • �'{' APN/1/K-I V' k9 PARCEL � <br /> IMP ) <br /> CNmER NAME S/'PF Rafro5 PHONE <br /> OMNERADIMIM CITYISYAT"IP <br /> Co RUMOR l2 5Z- ,SG/ PHONE - d <br /> CONTRACTORADDRESS CITVISTATU71P ITO <br /> LICENSE O C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPrN: R GEOGRAPHICAL INFORMATION: Coordinates X V f <br /> ❑ PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAHUAnurTONN E V[ .JI <br /> D REPLACEMENT O L O 'I <br /> — INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ER I <br /> NUMBER OF LIVING UNITS; NUMBEROFBEDROOMS: U <br /> (3I,,�,e,J 'E)ilf llhlll It <br /> SEPTICTANK TYFE/MFG CAPACITY work haing mimwp.li3atwLLdT.imtapected <br /> ❑ GREASETRAP - 9YPEIMPo CAPACITY L. .•g)1,-,I� r n® S1en I. <br /> ❑ PEG TX PLANT DIETANCETONGRESI: WELL A FOUNDATION ft PROPERTY LME fl 1 <br /> ❑ LIFT STATION SIZE TYPEOPPUMF - 1. ❑ SAND OIL SEPARATOR(ENCLOSEDSVSTEM) ~e' <br /> II <br /> lf( LEACH LINES ❑ LEACHING CHAMBERS #OF,LMES 1�. LENGTH OF LINES 0_0 ft <br /> r <br /> DIRAXCE TO NFARE31' WELL R FOUNDATION gyp'+ fl PROPERTY LINE R <br /> ❑ FILTER BED WRTX R LENGTH ft DEFFN R <br /> DURANCE TO NEAREST WELL M1 FOUNDATION R PROPERTY LINE -rR <br /> ❑ MOUNDED WHITx ft LENGTH R DEPTH ft <br /> r DISTANCETONEARER WELL R FDUNDATION ft PROPERTY LINE R <br /> 01"A SUMPS Wlmx Z R LENGTH fl DEPTH 14R ft <br /> DuirmcETONEARr'81' WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wurx ft LENGTH ft DEPTH fl <br /> RIB DISTANCETONEAREW WELL R FOUNDATION R PROPERTY LINE R <br /> SEEPAGE PITS NUMBER I WIDTH 3 ft DEPTH <br /> DISTANCETONEAREST WELL ft FOUNDATION_+d•r R PROPERTY LINE fl <br /> ` I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE MINE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUI N COUNTY. <br /> MINIMUM u(� OUR ADVANCENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> nnWYYS� FT 1y <br /> SIGNED�A\ jG� TITLE DATED-DI -O / <br /> Bm <br /> IN <br /> V <br /> NIL1 <br /> gA <br /> c / <br /> r <br /> Bm - <br /> 1 <br /> R� <br /> r <br /> I C <br /> v t.... . <br /> Wlmtbn AeaeM B Dtle Z Alm <br /> AREm IUYm IDM <br /> Flml lnrpmtlon By Dale ❑ SPECIAL PERMIT-Approved by <br /> ClMnder oJSnll W Depth 9173 FI: � Pit/Sumpmp Sail Character: <br /> C MMENfS Ak�V 6F a T�.T�,Ag, IW VfirRa+fl0✓ jr fntL, TMPF :5V <br /> _ I <br /> PE SC Recelved Ch Amo..t Date Per IU lovolee# PermllI M <br /> Code INFO B Ceeh Remitted Service Ueetx <br /> 71vis,11511 -1-0 <br /> ICI <br /> 42Meel 0%014 A <br /> IVO •✓(��/P/ _ ER• t�J <br /> ` �.IL33GMl <br />