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Lir; <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> - <br /> SASJOAQUINCOIIN'1'VENVIRONMENTALHEALTHDEPARENIENT 304E W'ERER AVE-3°O FL-STOCKTON CA 95201- (209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRM 15,;N90. Al. CITY/ZIP f/iJ�•' <br /> Lr 2 8 <br /> CAOSB STREET (( API Cl(.S-G'2L "CiS PARCEL SIZE �' <br /> OWtiER NAME 1 �N�--T PHONE ,`f•, <br /> LOWNERADDRESS CITYISTATE/ZIP y <br /> CONTRACTOR PHONE E� <br /> CONTRACTORADDRER4 <br /> L Cfll'/STATVZV <br /> LICENSE M42 Li C-36 OTHER NUMBER na EXPIRATION DATE <br /> WATER TABLE DEM: ft GEOGRAPHICALINFORMATION: Coordinate. X Y <br /> ❑ PERC TEST p BUILDING I LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDRION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERYE: RESIDENCE ❑ COMMERCIAL ❑ OTHEa <br /> NUMBERN LIVMNG"ITS. <br /> I NUMBER OF BEDROOMS: NUMBEROFEMPLOVEE4: <br /> 1 � Ar'c4✓ <br /> L ❑ SEPTICTANK TYPEIMFG e'/eew 4d CAPACITY 7 00 gel #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG / CAPACITY gal NOFCOMPARTMENTS <br /> /rP J IQ R <br /> [3 PION TX PLANT DISTANCETO NEAREST: WELL JJ R FOUNDATION Y ft PROPERTYLINE A <br /> L ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) _ <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES �Io 4 It <br /> DISTANCETONEAREST WELL a FOUNDATION �_It PROPERTY LINE �sd ft <br /> L ❑ FILTER BED WIDTx ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R ? <br /> ❑ MOUNDED wunti ft LENGTH ft DEPTH ft <br /> DISTANCETONEARMT WELL fl FOUNDATION R PROPERTY LINE R L <br /> ❑ SUMPS wwrr ft LENGTH Fl DEPTH ft -11 <br /> y DISrANCETONEAREST WELL it FOUNDATION R PROPERTY LINE It Tt <br /> ❑ DISPOSAL PONDS w,mR R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLNE fl r_1 <br /> SEEPAGE PITS Numant e^1 WIOTx '3" R DEPTH JS a ft C <br /> R <br /> 6. DISTANCE TO NEAREST WELL IIQ ft FOUNDATION R PROPERTY LINE 40 V ft TT <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY I' <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. C <br /> BIINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-7697 �� <br /> `EB SIGNED TITLE DATE DATE �Q <br /> -�[ L. 0_ <br /> L <br /> 1 <br /> L <br /> - - ----- - -----*' ---- - 11[[u--- [ <br /> ll' <br /> E <br /> VH O F <br /> E - <br /> 1 <br /> " -DEPARTMENT USE OA/L,Y <br /> E` DMe '3 241' Area Employee ID# <br /> Appllation Accepted B` �j-a <br /> FOI.I m perli9n BY 5 �4 - Dale /�/�� ❑ SPECIAL PERMIT-Appmvrd by <br /> Charaefer of SAil to De 9f3 FT. Pit/Sump Sail Character: <br /> COMMENTS 1zJ^:Et<:K'_• - / ' <br /> L <br /> PE SC Received Ch Amount Date Permit/ I., Ice Permit IM <br /> L Code INPD R Remitted S n9nA uettp <br /> y z_i� ITS 0-r P`-J- t.-u ,3 D7 �7K ''L 'm 1, "' 7 / <br /> .+mm, ONSITE WASTEW.4', `/ <br />