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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY BNVIRONAIMAL HEALTH DEPARTMENT 304E WEBCR AvE-3"FE-STGCKToN CA"M-(20)4U-343O <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADORess m crrr/IJP-IkAC✓ 9s35v/gf3kJ(I <br /> —f <br /> CR09E SFREEF CNK/IM.61N1 APN <br /> OWNER NAME 9AmnBllJ��//R�le5 .PRONE a76-3 -73 <br /> QWNES <br /> AHOREBR 1049Z &XSr L/.V/A/E RG.4J) CRVB)TATFIGP //C.4C�( 95177 <br /> CONTUCT'oa C/-fE NE CnNiGlt /rV <br /> PHONE lPG'fd-- <br /> COM'RAROa AODRessfl. aQX 7 llaj CiTYWATULn c <br /> LICENSE 13 C-42 11 C-36 OTHER NUMBER E%PIRATIONDATC <br /> WATCR TABLE DEPTH: OFT— It GEOGRAPHICAL INFORMATION: CBOEHinRteS X Y <br /> ❑ PERCTEST Y ~I BUILDINCPERMITM LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTALIATIOM ❑ REPAIR/ADDHTON ❑ ENCINEEADFEICNED/ALTLRNATVC <br /> ❑ REPULSME O DFsrRurnoN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 13 COMMERCIAL ❑ OTHER <br /> NUMBER OP LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMBAVEM, <br /> ❑ SEPTICTANK TVPFINIM CAPACITY RBI 00F COMPARTMENTS <br /> ❑ GREASE TRAP TYPEAfFG CAPACITY pi BOF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTAncETONEAREsT: WELL ft FoumaATMN It PROPERTY LINE fl <br /> Cl LIFT STATION SITE TYPE OF PUMP O SAND OIL SEPARATOR(ENCTOSXD SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOF LINES LENGTH OF LINES R <br /> DI[TANCETGNEARESE WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISIANCETONEAREBT WELL IF FOUNDATION R PROPEMYLIFE R <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH <br /> DISIANCETONEARESI WELL R FOUNDATION It PROPEATYLINE R <br /> ❑ SUMPS WIDTH ft LENGTH R DEPrH R <br /> DIRTANCETONEAREST WELL ft FOUNDATION R PROPERTY LME R <br /> Cl DISPOSAL PONDS Wmm ft LENGTH R DEPTH R <br /> DvTANCETONEARESf WELL R FOUNDATION R PROPERTY LINE <br /> ❑ SEEPAGE PITS NUMUR WGHD It DEPTH R <br /> Dv;rANCETONEAREST WELL It FOUNDATION R PROPERTY LME ft <br /> I HEREB5CETHATI EPREPAREDTHIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O INANCES,STATE TAWS AMD RULES AND REGVLATIONS OF BAN JOAQUIN COUNTY. <br /> MI 4 URADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2N)9534697 <br /> SIGNED <br /> TIME DWS DATE <br /> - I <br /> of UI <br /> - -4 119 <br /> - - .. . .. . <br /> ,._. DEPARTMENT USE LY.0 I�V <br /> AppIkRHRe AaEptd B Deh �P /!Y Am EDlpbya IDN J(H <br /> M..l1,apaHoeBy -%? /.!`n Dete ❑ SPECIAL PERMIT-Appmvd by <br /> CWnehr.f SBll h Depth Bf3 FH <br /> COMMENTS PIUSuntp SDB CNTBM: <br /> !�-�-�S- J Ev.�6s, w�.. t);?� ::Fsi ' YP� �r7I <br /> PE SCRecelveH etld/ Annue[ Mh Perm1U IDvoleeM Perldt lDp <br /> Code Into B RevHRd ServkeR eeHM <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> IL2Y1003 <br />