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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CouNn ENHaDmIENTK HF TH DEPAMMENI 600 E MMN STREET-STOCNTON CA 95202-(209)6683620 <br /> NON-REFUND <br /> ��A <br /> QBL <br /> LE2E PERMIT ��F� CALL 2099)9re55�3-7697 FOR INSPECTIONS EXPIRE�St1�YEAR FROM DATE ISSUED <br /> JOB AOOREN, . 3" S. T,p{Jc 'TON6 /�-fJ• CmZP O'AAA•I—f£✓Fl ���/ A� <br /> cROGs STREET opL.,O f`�• Ti,-'-C-pE� ,, APN '2O$—O`I'0-03 PAacaLs6E� > <br /> O BRNAME I/\ I ✓AN l+�F-,•,rINGE� PHONE <br /> OmSeAooaEss IS1-1CP cm)swazP MhN fC—A lfA 91331P <br /> cotrtaAcroa Lw �[TO MCK GEGEN V I P-0Il M if N TA L. PHONE 3b9 —o3-35— <br /> cONTRACTORADORBSa A-i W. O fYK Sr- CrtTISTATEZP L-OD I 64N 'IV <br /> LICENSE QC QC36 OTHER NUMBER EIOIRAnONDATE <br /> WATEETABLEDEPIN: R GEOGRAPNICLL INFORMNnIXI: Cocr inates X Y <br /> PERCTEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK ❑ NflYINSTALLATON ❑ REPAINAO01110N ❑ ENGINEERDENGNEO/ALTERNATNE <br /> ❑ REPLACEMENT ❑ DEETRUC110N <br /> INSTALLATION WILL SERVE: ❑ REBmENCE ❑ CoMLteac AL ❑ OTHER <br /> NUMBER OF LMNG ON=: NuEHNNOFBEO1t0OW: NUMBEROFEMPLOYEES: <br /> O SEPTCTANK TYPEIMFG CAPACTrY gat #OFCAMPA MENT <br /> D GREASETRAP TYPE/MFG CAPACITY Bal #OFCOMPA MENT <br /> DWANCETONEAREST: WELL R FWN TION ft PROPERTYLINE ft <br /> D LIFTSTATION SOX TYPE OF PUMP ❑ PKG TX PLANT ❑ SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> D LEACH LINES ❑ LEACHINGCHAMSERS #OF LINES LENGTHOFUNEB ft <br /> Do TANCETONEARETT WELL R FOt)NDATION ft PROPERTY LINE R <br /> D FILTERBED WIDTH ft LENGTH R DEPrH ft <br /> DWMCEMNEAREBT WELL R FOUNMnON ft PROPERTY LINE ft <br /> D MOUNDED WnRN ft LENGTH R DEPTH ft <br /> DISTANCETONFAREBT WELL R FOUNDATION ft PROPEFT'LINE ft <br /> O SUMPS WuxH ft LENGTH ft DEPTH ft <br /> DWMCETONEAREST WELL ft FOUNDAMON ft PROPERtt LINE ft <br /> D DISPOSALPONDS va. It LENGTH R DEPTH ft <br /> DISTANCETONEARFBT WELL It FOUNDATION It PROPERTY LINE ft <br /> O SEEPAGEPITS NUMaeR WImN R DEPTH ft <br /> Dw,NNCETO NEAREST WELL ft FWNOATON ft PRCPEIGY UNE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THEW MMI-1-BE DONE IN ACCORDANCE WTM SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> HIM U URADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASECALL(209)9W.76W g <br /> SIGNED TITLE CONN L-Tie iy DATE o —17-0 <br /> Z <br /> ~ <br /> D r <br /> _j LU W o 0 <br /> g e-_ LLI > v <br /> Lu <br /> zoWewa< <br /> - ¢I ! <br /> fit: <br /> I. <br /> LLI <br /> �. 6 ! o' = Q mow¢ <br /> Z < <br /> LU <br /> •OEMENATm RDINNPu• 8 InYfk <br /> x <br /> Y - - <br /> Q�JrJA DEPARTMENT USE ONLY _ <br /> Application Aaeepbd BY�"�' Data --6-7—A-1 J Area Employee ID# ^ <br /> I'mal Inspection By OaHt p SPECIAL PERMIT-Approved by <br /> Character Of Soil to Depti1 of 3 Fl: PiV$ump Soil Character. <br /> COMMENTS <br /> PE SC Revived CheCIOTI Amount Date P.IV Involm# PermRlgi <br /> Code IHro B Cash Rem' Service Re oast# <br /> 9aaa 2\ c0 <br /> d?-0t ON511E WASTEWATER TRTMNTSVSTEM PERMIT <br /> taaroT <br />