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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAT JOA0 ry COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOctcToN CA 95205.(209)468-3420 <br /> NON- NDABLE PERMIT CALL 209 953-7697FoR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> on 'ICN �- 1_I N<NC CDYZP_j,Fq __ 1S�I'.� , , <br /> STREET_! / APN � � YO �d PARCEL SIZE <br /> A <br /> OWNER NAME S,�TN r1-m =��D.4,1)-- _PHONE r2i101 7 A A'1—A <br /> E[ <br /> OWNER ADDRESS � CTY/SAELP2' DU � <br /> CONTRACTOR / pRONE <br /> CONTRACTOR ADDRESS CRYISTATEILP <br /> LICENSE ORC42 ODCa6 OTHER _ NUMBER_______EXWiAnONOATE <br /> WATER TABLE DEPTH: I D 1 _11 GEOGRAPHICAL INFORINWH NI: COOrINR11103 X Y <br /> O PERO TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Il NEW IT�TALLATION I. REPATVADDIrKIN O ENOINEEROESIGNEOIALWMATWE <br /> ❑ REPLACEMENT 11 OUT-OFSERVICESEPTCSYSTEY ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ,/CI RESIDENCE LI COMMERCIAL El OTHER <br /> NUMBER OF LIVING UNDS: K I NUMBER OF BEDROOMS:_ LI NUMBER OF EMPLOYEES: <br /> L- <br /> T /+���, <br /> SEPTIC TANK TYPE/MFG .VIICC��— f/TI 014W CAPACITY Io/III' gal #OFCOMPARTMENTS�,� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS__ <br /> DISTANCETONEAREST: WELL R FOUNDATION It PROPERTY LINE 8 <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES [i LEACHING CHAMBERS___ __ #DFLINES_ LENGTHOFLINES - ft <br /> DISTANCE TO N"AEST WELL— R FOUNDATION It PROPERTYLe1E It <br /> ❑ FILTER BED WIom_____ ____It LENGTH --ft DEPTH It <br /> DISTANCE TO NEAREST WELL__ R FOUNDATION R PROPERTYUNE It <br /> ❑ MOUNDED WIDTH _,__ It LENGTH # DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH N LENGTH R DEPTH _ 8 <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH ft <br /> DISTANCETONEAREST WELLR FOUNDATION ft PROPERTYUNE ft <br /> ❑ SEEPAGE PITS NUMBER___ WIDTH R DEPTH _It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WDH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209)953-7697 <br /> SIGNED_ TITLE DATE <br /> FF <br /> etc <br /> O �C <br /> �D <br /> ❑ 15 <br /> ID <br /> un�y <br /> DEPARTIIIENT WEy �- <br /> Application Accept Gate .._. .. Area y Q Employee IDM 74t 51 <br /> FIRE]Inspection By %Data 0 SPECIAL PERMIT-ApproveA by <br /> Character of Soil to a th of S t: 7 /� VSump Soil Character. <br /> COMMENTS L# <br /> / '7 .✓ <br /> PE SC Received Ch k#/ Amount PermW <br /> Code Itso 8 ,Cas - Remitted, Dale EuRV, Request# Invoice# Pitman ID# <br /> a �.oa �1z s �l z83 <br /> 4MI ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> AWanP <br />