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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> OAQUINCOUNTYENVIRONMENTALHEALTH DEPARTMENT 304E WEBER AYE-3"'FL-STOCKTON CA 95202 - (209)460-3420 <br /> -REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTI O{S EXPIRESI YEAR FROM DATE ISSUED <br /> f C/tn' l PC�yfi jnS-Z/1 <br /> L{pDNE55 - Y/ZIY <br /> CIT = <br /> STREET t APN / PARCEL SIZE 4.7cl:ilvS o <br /> NaME 2/✓ �`/�H'C��IC PHONE <br /> NER.4DDREES ��J CIT'/STATEJZIP ^� <br /> LRACTOR "�✓ /•I /•�• C- PHONE <br /> J[Jn�A <br /> JIRACPOR ADDRESS -G( f/DY" 4O CITISTATFJZIPSJR'— <br /> ,tj zz v <br /> SE 43 ❑C-36 OTHER NUMBER S E%PIRATION DATE <br /> R TABLE DEPTH: 2_l% fl GEOGRAPHICAL INFORMATION: CODrdIDLLeS X Y `•` <br /> ERC TEST(9) NUMBER LAND USE APPLICATION# <br /> PE OF WORK: ❑ NEN'INSTALLATION .15: REPAIWADDITION ❑ ENGINEER DESIGNEUTALTERNATD•E <br /> ❑ REPLACEMENT �ayy ❑ DESTRUCTION <br /> ALL.{TION WILL SERVE: ❑ RESIDENCE /COMMERCIAL ❑ OTHER <br /> bp NUMBER OF LIVING UNITS: �!!T ^�.aa�J NUMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: <br /> _ <br /> SEPTICTANK TYPEJMFOI�J'J�A-TTC'� '5i�/��/ CAPACTn® gal #OF COMPARTMENTS <br /> CREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTE <br /> L1'%G TX PLANT DISTANCETONEARESI': WELL A FOUNDATION R PROPERTY LINE / V D <br /> LIFTSTATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 4 EACH LINES K LEACHING CHAMBERS //1 #DF LINES 2 LENGTH OF LINES �. i JJJ\\\ <br /> DISTANCETO �� _�n <br /> NEARRST WELL FOUNDATION D PROPERTY LINE S— H <br /> FILTER BED WIDTH fl LENGTH R DEPTH f, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION f5 PROPERTY LINE fl <br /> LMOUNDED WIDTH fl LENGTH A DEPTH <br /> DISGNCETONEAREET WELL fl FOUNDATION fl PROPERTY LINE fl <br /> SUMPS WIDTH fi LENGTH fi DEPTH fi <br /> DISTANCETO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> LJISPOSAL PONDS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL fi FOUNDATION fl PROPERTY LINE fl <br /> SEEPAGE PITS WIDTH fl LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE (1 <br /> 1wLEYCERTIFY 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 COUNT'. <br /> MI UM 24 HOUR ADVANCE NOT ICE REQUIRED FOR INSEE IONS-PLEASE CALL(20q)q53-7697 <br /> LED GR N+ TIME DATE <br /> f <br /> 4 Y <br /> 4 <br /> ord <br /> 4. <br /> S <br /> 1 AN M NiTAL .. <br /> Lr <br /> ITS <br /> f3� <br /> I _ <br /> V <br /> DEPARTMENT,USE ON S' <br /> sian Attepted B _. Drlc .] (i L e Area a-(L• Em loee 139 <br /> Ain <br /> pY 7 <br /> spedion BY Dne_( `� ❑ SPECIAL PERMIT-Approved by / <br /> L1:71, <br /> : 1,Soil to plh Of J FE ' PH ump Soil Chaeacler: <br /> MMENTS ',)h ti R!'51,4, 1-. <br /> S SC Received Cheq,kaft' Amount PermiU <br /> rde IFFO By `Cash Remitted DBfe Service Re uest# Invoice# Permit lD# <br /> L <br /> .1 <br /> ,0� ONSITE WASTEWATER PERMIT <br />