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` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN <br /> CA"202.czo9)AMaaM=o <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> CALL 709 95}7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> NON-REFUNDABLE PERMIT <br /> L'C-14-K--- F-o cmmP <br /> Jos ADDRESS �T.-- > <br /> AM 49 <br /> �/" D � �- PARCELSEM g <br /> GROES MEET v4ze hA. R-T PHONE 1-�h�a 111 <br /> -Tore <br /> OWNER NAME J <br /> - - - L I cm/sTATFnA. T�fa 9 C 2 4• <br /> OWNER ADDRESS n <br /> L) PHONE r <br /> CONTMCTOR Q , <br /> CHYWAl9lLIP <br /> CONTMROa ADDRESS <br /> LICENSE ❑Cd= ❑C-36 OTHER <br /> NUMBER E%PIMTION DATE <br /> WATENTARLEDUFTN: D CEOGMPNICAL INFORMAnON: CNI dirree X Y <br /> i FERC TEST -X BUILDING PERMIT# - LAND USE APPLICATION# <br /> ❑ RLPAIP/ADDInIXi ❑ EHGIN[LR DPSICNEO IAM DONATIVE <br /> TYPE OF WORK: O NEw INSTALLATION (3DESTRUCTIONREPLACEMENT <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVINGUNFB: NUMBEROF BEDROOMS: NUMBEROFEMPEOYEES: A� <br /> ❑ SEPTIC TANK TTPFJMFO CAPAC" IS' NOFCOMPARTMEMS \r` <br /> ❑ GREASE TRAP TVPUMFO CAPACm pl MOF COMPMTMENIS �. <br /> ❑ PKG TX PLANT DISFANCE"NEARf9f: WELL fl FDUNDATRJN ft PRomuTV LME ft <br /> ❑ LIFT STATION SRP MEOFPuMP O SANDOILSEPARATOR(ENCLORDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS MOFLMEE LENOTIFOFLNES ft <br /> DIBTANCETONLARM WELL—ft FOUNDATION fl PROPERTY LINE BR <br /> ❑ FILTER BED WOOD ft LENGTH It OEM <br /> DUMANCETONEARL411' WELL ft FULINDATION ft PROPERTYLME ft i <br /> O MOUNDED w1uTx ft IENGTH fl DEM R C <br /> DIETANCETONE1RPbT WELL R FOUNDATION fl PROPERTY WNE ft Ty <br /> ❑ SUMPS WIDTH ft LENGOI R DOMI ft Z <br /> DinANCETONEARFSr WELL R FOUNDATION fl PROPERTY LINE ft <br /> O DISPOSAL PONDS W--—ft IENOHI ft DEPTH ft () <br /> DISLANCETONEAREST WELL ft FOUNDATION fl PROPERTY LNE R <br /> ❑ SEEPAGE PITS NumaSR WMN ft DEPTH ft <br /> DISTANCEMNEARESr WELL ft FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFV THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT' f <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IV <br /> MINIMUM=e HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(=09)9534697 J <br /> SIGNED - - TITLE.--- ,I-' - DATE E+ O yv <br /> 16 <br /> In 2 <br /> 94 <br /> R <br /> CN <br /> A <br /> 1 <br /> PARTMENT USE ONLYI / <br /> AppIkOBOn Aca,,t M By Mk Ara EmVloya IDM <br /> Final inspection By Mie ❑ SPECIAL PERMIT-Appme by <br /> Chamter of Shc to Mpth of 7 FU NUSump SOB C6Rrsckr: <br /> COMMENTS f 1 <br /> PE SC Rad— n <br /> J AnYa PIn <br /> ermlU WkeM USE <br /> M <br /> COMB INPD CaTh ReMReM Mk sD,&e IMRt <br /> . ,., <br /> ONSITE WASTEWATER PERMR <br /> eJL=-0EI <br /> SIR I=tm <br />