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ONSITE WASTEWATER TREATMENT SYSTEM PERM6U <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCK roN CA 95202.(209)468.34" <br /> NON-REFUNDABLE PERMIT CALL 1'209 953-7697 FOR INSPECTIONS, EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jo6ilkone 3 b g`- Cln/7LIP C-oD/ Ci} 95z /D <br /> CROSSSMET 164Ji 919' APN DG13- 1SU--2-6,, PARCELSME 47-9-3 D <br /> �d�fiOWHERNAME D PHONE 7"//�p�•�J[1 <br /> OWNER Amutm JJ CRY/STATEZIP <br /> CONTRACTOR �I /� / /�. G y�- <br /> � PHONE %31 <br /> CONTRACTORADORESS CLFY/STATE21P 5�41�n-1 / <br /> LICENSE _J�1;42 ❑C-36 OTHER ✓ HUMMER EXPIRATION DAT! <br /> I <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFOItMATTON: Coordinates X Y <br /> ❑ PERC TEST p BUILDING PERMIT 11 - LAND USE APPLICATION# <br /> TYPEOFWORK: Y NEW INSTALLATION REPAIIVADOITION ❑ ENGINEERDENGNEOIALTERMATME <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 115 COMMERCIAL OTHER L <br /> NUMBER Oil,LIVING UNR3: NUMBER OF BEDROOMS: NUNSEROF ENPLOYElS: M <br /> {w4- SEPTIC TANK TYPEIMFG �!� CAPACRY 2000 981 #OFCOMPA ENTS f-O <br /> ❑ GREASETRAP TYPE/MFG - CAPACITY <br /> gal #OF(AMPARTMENTS n <br /> ❑NRANGE TO NEAREST: WELL /07 flL FOUNDATION—� fl PROPERTY LINEAL fl O. <br /> LIFT STATION SIZE TYPE OF PUMP O PKGTXPLANT D SANDOILSEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION fl PROPERTY LINER R1 <br /> ❑ FILTER BED WI <br /> ft LENGTH ft DEPTH it r <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTYLINE It <br /> ❑ MOUNDED WIM ft LENGTH ft DEPTH it C <br /> DISTAHCETONEARa6T WELL ft FOUNDATION It PROPERTYLINE it <br /> ❑ SUMPS WIDTH R LENGTH It DEPTH ft O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTYLINE it <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH It DEPTH h <br /> DISTANCETONSAREST WELL ft FOUNDATION R PROPERTY UNE ft iL <br /> ❑ SEEPAGE PRS NUMBER WIDTH R DEPTH ft <br /> DIsTANCETONEAREIT WELL ft FOUNDATION It PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE GONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OROINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IMUM 21 N0 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE C-4-0 DATE <br /> 41072,L4M <br /> ;4 W74 <br /> • r I <br /> I <br /> �r• DEPARTMENTU E Y�"I"'i�"-'"' <br /> Q� � <br /> Application Aeeaptetl - �— Dm ///'f7 Am Empbyee lDp y 9� <br /> Flrial Inspeotlon By _mss DMe 9��j�j� ❑ SPECIAL PERMIT-Appmwad by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Sol[CFleractx: <br /> COMMENTS f-D -"fE INTO £`F-[L77�31C, LLdrst >cE>EC_A T � <br /> PE SC R_I._d saW Amoum Dab Petmitl <br /> FD 8, <br /> Irrvolp# PBm1tt IDN <br /> Cooa IxRemittaO ServicaR usstp <br /> Z!-T I AS/ <br />