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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAD'OIN COUNTY ENVLRONMENTAt HEALTH DEPARTMENT 600 E MAIN STREET•ST'OCKTON CA 95202•(2091 468 120 <br /> NON-REFUNDABLE PERMIT CALL 12 9)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> t i C , ,P 0'1Xw .n ; <br /> „F9!AD4RE33 – _ <br /> la-a _ _APN PARCEL SIZE O <br /> CROSS STREET t'T F..Iq <br /> OTYNER NASI[E �,�4!1 00 PHONE 1 I �d <br /> OWNER ADDRESS `P� CmlSTATLfZtp <br /> CONTRACTOR �►7 r�I��+�S "' -• ✓G C PHONE <br /> CONTRACTOR ADDRESS CITYlSTATElZW .4 <br /> LICENSE QC-42 QC-36 OTHER _i NUMBER(a&J5;�EXPWATION DATE Ono 16 <br /> WATER TABLEDEPTH: ft GcooRAPNICALINFORMATION: Coordinates X Y . <br /> PERC TEST * BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPEOF WORK: NEW INSTALLATION ,. REPAIR1AO6IT ❑ NGINEERD GNEDIALTERNATNE <br /> C REPLACEMENT L; OUT-OF-SERVICE SEPTIC SYSTEM D ,DESTRUCTION <br /> INSTALLATION WILL SERVE: U RESIDENCE a OMMERcuu. ❑ O1MER <br /> NtimsER OF LMNO UNITE: NUMaER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> `Q'-SEPTIC TANK TYPE W'r' P�-^ CAPACITY—/A� pal X OF COMaART.ENIS <br /> U GREASE TRAP TYPEJMFG CAPACITY_ 1 CMI #OF COMPARTMENTS y <br /> DISTANCE TO NEAREST: WELL_ I�O ft FOUNDATION '14 ft PROPERTY LINE_� f h <br /> U LIFTSTATION Sim£ TYPEOFPuMP Q PKGTXPLANT GiANDOIL SEPARATOR(ENCLOSED SYSTEM) <br /> lj--LEACH LINES �' �J LEACHING CHAMBERS XOF LINES I-LENatH OF LINES A e<5yTER <br /> DISTANCETO NEAREST WELL ! ft FOUNDATION Q+ ft PROPERTYLINE Jfi� : ft <br /> O FILTERBED WIDTH ft L ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNOATION fl PROPERTY LINE ft \ <br /> Ll MOUNDED WIDTH ft LENGTH ft DEPTH ft \ <br /> DISTANCE TO NEARK4T WELL ft FPUNOATION ft PROPERTY LINE <br /> m--sumps Z WIDTH _2L_� ft TH ft DEprm /d •� ft <br /> i DISTANCE TO NEAREST W 010 ft FOUNDATION ft PROPERTYUH� ft \ <br /> O DISPOSALPONDS WIDTHft LEND ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY UNE ft <br /> 0 SEEPAGE PITS NLWNER WarrH It DEPTH ft \ <br /> DISTANCE TO NEAREST WELL ft FOUNDAnON fl PROPERTY LINE ft <br /> hi REBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOADUIN COUNTY ORDINANCES, \V\ <br /> 1 STATE LAWS AND RULES AND REGULATIONS Of SAN JOAQUIN COUNTY, lv\1 <br /> MINIMUM 24 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953- 97 <br /> SIGNED TITLE: C-0M1+ ec4or DATE <br /> \V <br /> I FT <br /> I I <br /> I <br /> N <br /> H <br /> DEPARTME <br /> Employee LDAI �OL� <br /> Final Ina Ion By -vote SPECIAL PERMIT•Approve try <br /> Character of Soil to apth of 3 Fl: P Imlp SOH G 7MItGter: <br /> COMMENTS - 5 11 to ., + rct •'4 <br /> SC Received Chat Amowd Dave Imrolcell PWMIIme <br /> Code TMPD RemkW Sarvlos Re t I <br /> �b 1 q(oti 4'� o. <br /> 42-01 / ONSITE WASTEWATER TRTMNT SYSTEM PERMFY <br /> k{ Erz6+0a <br />