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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER APT-3"FL-STOnITON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> VL O n CrrY IP O <br /> JOB ADDRP38 11770 C. <br /> ;y, /� M> <br /> cR STREET TT (/`•,,., // ego APN Ola ZA -1n00 ^( 1 PARCEL SI KJ �L• O <br /> �l ONE 134.79 0 <br /> OWNERADDRESS ' I2. 19 2 T-e �� f 1�4 1� CITI'/RTATF21P I/A �1 i';'2 <br /> CONTRACTOR O PHONE <br /> V <br /> CONTRACTOR ADDRESS CRV/STATPlLIP <br /> LICENSE (3 C42 OC-36 OTHER NUMBER E%PIRATIONDATfi `N <br /> WATERTABLE DEPTH: A GEOGRAPHICALINFORMATION: CoordiRees % Y <br /> PERCTEST # I BUILDINGPERMIT# LAND USE APPLICATION# AM hF <br /> TYPE OF WORK: NEW InsrAL1ATIQN ❑ REPAIR/ADDITION ❑ ENOTNEEIRDEAKINEWALTERNKTUVE <br /> O REPLACEMENT O DESPRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITE: NUMBER OF BEDROOMS: NUMBEROFEMPLOVEE3: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACDY gel #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACRY gel #OFCOMPARTM9NTS <br /> O PKG TX PLANT DIBTANCETON6AREBT: WELL ft FOUNDATION it PROPERTY LP'E A Q <br /> ❑ LIFT STATION SIM TVPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) p <br /> 1 <br /> O LEACH LINES ❑ LEACHING CHAMBERS MOP LIKES LENGTH OF LINES fl <br /> DISTANCE TO NEAREST WELL ft FWNDATION A PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH A DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION A PROPERTY LME It <br /> ❑ MOUNDED WIUTM ft LENGTH A DEPTH ft <br /> DISTANCETONEARFBT WELL ft FOUNDATION A PROPERTY LINE ft <br /> ❑ SUMPS WIBTH ft IJfNOTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL A FOUNDATION M1 PROPERTYLINE ft <br /> ❑ DISPOSAL PONDS WWTX A LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUMBER WroTN fl DEPTH A <br /> DISTANCETONGREST WELL A FOUNDATION a PROPERTY LUNE fl <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR I NSPECHONS-PLEASE CALL(209)953-7697 <br /> / q <br /> SIGNED __2'I7LE C F �.� DATE 1^Z 0�O� <br /> u. <br /> :14 <br /> 300, <br /> E <br /> 11coll <br /> DEPART Nil' E Y <br /> Application Accepted B Det. 4 0'� Am Employee IDN S3&& � <br /> Fi..I IF.P.d.R By Date 9/�9/es ❑ SPECIAL PERMIT-Approved by <br /> Chancier of Soil to Depth 9f 3 FI: PR/Sunp Sol[Character: <br /> COMMENTS <br /> /��� 7/���� &7i, 7f�5 /l;i%;'607 l/K 03 .3 <br /> PE SC / Reedh ed ee A...t �t< PermlU Iovolee# Pord1IM <br /> Cod. INFO B uh Remitted Servlee uMa# <br />