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S'/o <br /> ONSITE WASTEWATER TREATMENTT SYSTEM PERMIT <br /> SAN JOAQUIN CO"NWiNVIRONMENTAL HEALTH DEPARTMENT N /11 WEBER AVE-3-FL-STOCKTON CA 95202-(209)08-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)95}7697 FOR INSPl.2`I'IONs <br /> EXPIRES YEAR FROM DATE ISSUED <br /> JOB ADOREM / CJ CRYIZIP 1-1 . .4 C <br /> CROSS STREET APN 009- 110- ©6 PARCELSIZE Ill Yk. <br /> OWNER NAME 'SeFIN I 'A-�Q(L/YNl PHONE <br /> OWNERARYRFSS SAm /� CITY/$TATPJZIP <br /> �--" <br /> CONTRACTOR n{ 1�1�r�� '�o�r PHONE�3,�C1-5V2 <br /> CONTRACFORADDRESS,JII/JlJ E- �7WG. CITY/STATFJZIP <br /> LICENSE SLC-42 0C-36 OTHER NUMBER J- EXPIRATION DATE O/ C <br /> WATERTABLEDEPTH: ft GEOGRAPHICAL INFORMATION: Coordinate, R Y <br /> BIBB ❑ PERCTEST(S) NUMBER of LAND USE APPLICATIONS <br /> TYPE OF WORK: ❑ NEW INSTALLATION y^ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> C <br /> INSTALLATION WILL SERVE: ❑ Rempervce ❑ COMMERCIAL El OTHER <br /> r' NUMBEROFLIVINGUNTTS: NUMBER OF BEDROOMS: NUMBER OFEMPLOYEES: <br /> ❑ SEPTICTANK TYPF/MFG 3VIS'4ayS CAPACITY /SZCI gal 90FCOMPARTMENTS 7 C <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ►a ❑ PKG TX PLANT DISTANCETONEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> (3 LIFT STATION Sim TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSEM) <br /> (211� LEACH LINES ❑ LEACHING CHAMBERS Of LINES LENGTH OF LINES ge) r R <br /> DISTANCETONEAREST WELL ,VS" R FOUNDATION iU R PROPERTY LINE /CYJ/r ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DIWANCETONEAREYT WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> ` DISTANCETONEARESP WELL ft FOUNDATION fl PROPERTY LINE ft 5 <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH IT <br /> DISTANCETONBAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> Bm DISTANCETONEARL9r WELL ft FOUNDATION fl PROPERTY LINE R <br /> ❑ SEEPAGE PITS Wmnt 3iG JI fl LENGTH B DEPTH .25- 0 <br /> DIWANCETONEAREST WELL 1Za c" ft FOUNDATION ft PROPERTY LINE /yJ/i— R <br /> ` 1 HEREBY CERTIPYTHAT 1 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 /> MINIMUM L HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(20))953-7697 <br /> SIGNED — TITLE /res DATE '3 <br /> L <br /> G 1 <br /> LIB <br /> L <br /> P <br /> c. j-�4f <br /> p AL SE <br /> N <br /> i l <br /> DEPARTMENT USE ZON Yl <br /> Application Accepted By TMJ Data Area ( L Employee iD <br /> Find Inspection B Date ❑ SPECIALPERMIT-Approv Ii ny <br /> Chancterof Soll ptoft: fix_ Pit/Sump Soil Character:Nae <br /> COMMENTS <br /> y PE EC Received Ch Amount ate ParndU IBvoI9eM ParMtlDk <br /> Code INFO B aTh Remitted SerWC. .tR <br /> 142101 v - 4 0 9 <br /> L <br /> 42-M12 I- <br /> U ONSITE WASTEWATER PERMIT <br />