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t <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 East Hazolton Avenue-STOCHTON CA 95205.9232-(209)4983420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS e� Ft nrY�n G n R P CrrTmP F1 c !� ..i7 2 D - 9 S-2 3 / <br /> CROSS STREET' \'r(TSI L� APN� �L9, �uI PARCELSME b <br /> PHONk re, )k74_ C'14?3 <br /> OWNER NAME ^7a d9� H q - <br /> OVINENADDRESS p ^'n h� CM/IISTATE2W-fr1 - S2 <br /> CONTRACTOR ( ,rt �LAi*�S On� - _ PrIONEQ10: L((��{-13f <br /> CONTRACTOR ADDREssCitrisrwrE/ne_I•!-d✓1C1n fm_L..A`�U�. q'Sa2'�3f) <br /> LICENSE 2 [IC38 OTXER NUMBER / t2s?I E%PIRATION DATE Q-3\^\� sw 2- .7 <br /> WATERTABLEDEPric ft GEGGRAPXICALINFORTMTNIN: Coordinates X Y <br /> TYPERC TEST # BWLDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: D NEW WSTALLUnom xi REPAIR/AOORION ❑ ENGWEERDESIGNED/ALTERNATIVE <br /> L' RPPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: /-9: RESIDENCE ❑ COMMER♦CIAL O OTHER <br /> NUMOER OF LNWG UNRa: NUMBER OF BEDROOMS: O 3-Cd fC6M1 NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE(MFD CAPACITY gal #OFCOMPARTMEKTS <br /> ❑ GREASETRAP TYPENMFG CAPACITY gal #OFCOMPARTMENTS <br /> DaITANCETONEAREST: WELL R FOUNDATION it PROPENTY LINE ft <br /> ❑ LIFTSTATION SRM TYPE OF PUMP O PKGT)(PLANT O SAND OIL SEPARATOR(ENCLOSE TEM) <br /> B�LEACHLINES LEACHING CHAMBERS #OFUNE9 LENGTHOFLINES IP6,21 it <br /> _ DwTANCE TO NEAREST MIJ. _ft FIXMDATIDN fl PROPERTY LINE K <br /> ❑ FILTERSED WImN R LENGTH It DEPTN R <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYUNE ft <br /> L3 MOUNDED Wlmn U NGTN It DEPTH ft <br /> DISTANCE TO NEMEST WELLIt FOUNDATION ft PROPERTYUNE It <br /> ❑ SUMPS Wemf it LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSALPONDS 'MDTHR LENGTH ft DEPTH it <br /> DISTANCETONEAREST^ WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NOVBER Wwm ft DEPTH It <br /> DMTANCETONE EBT WELL II FOUNDATION R PROPERTY LINE N <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIOINSS-PLEASE CALL(209)953.7597 <br /> SIGNED TITLE 0NN tr-I CA Y- DATE" I ^I <br /> A <br /> T <br /> 1 <br /> DEPARTME E O LY <br /> Final inspection By .�i / - Dated[/6 lam_ SPECIAL PERMfi-Approvetl by <br /> Character of Soil pro.(3 R. / / Su p Soil Ctwractar. <br /> COk1MENT5 <br /> PE SC Recelvad Amount Date Parmit/ invaiw# ParmR W# <br /> Cada INFO amlttetl Servke Re nest# <br /> 38 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1ruaD7 <br />