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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT y ,yo <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JNEWVII AV¢-le'FL•STUCKTON CA 95103-(209)C6E-N20 <br /> NON-REFUNDABLE PERMIT CALL(209)957-7697 FOR INSPET.Tiom EXPI ES 1 YEAR PROM DATE ISSUED <br /> Jot,ADDREaF GG �l-+7/IDIO IJ. f` iLTL�R- C� Cm'iZIP /'I co ;V. F'•;: <br /> 1-? I� •.-� � <br /> CROSS$TREET t �LY//�--{G{..L``�'��1GF FA1J.{ �� APN ^ (�•J n •U PARCEL$ITP <br /> OWNER NAME T�•L-Iv�1..JJ �!1 P�L L , r -V-3Y III PNOVE <br /> OWNRRADORLA9 CITY/STATEIIP <br /> CONTRAc oR I �PMAE <br /> WNTCONTRCADMESS I BPC P"F Cm/STATM."55 <br /> y `N�•'7y�" <br /> LICENE ilC42 (3 C-36 OTHER NUM _7359 <br /> �5qo �/��Tti��GyjL�JqCJ�VJ' �rye1 <br /> EXPIRATION DATE_ <br /> WATER TABLE DEPTH: 0 GEaRAPHICALINFORMATION: C.Irdlntler X Y_ <br /> ❑ PERC TEST(S) NUMBER LANOUSEAPPIJLATIONO <br /> TYPE OF WORK: It NEWINSTALLATION ❑ REPAIWADI ❑ ENGINEEROPSIGNEO/ALTERNATIVE <br /> ❑ RCPLACEMEEwr ❑ DT'STRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> fi— <br /> M NOMDEQ OP LIVING UNTI9: /C�,I NUMREROPBEDsOOMS: Numom OFEMPLUYEPd: <br /> Y SEPTIC TANK TYPRI_y�(IwrvlT+ CAPACITY 1000 gTl #OFCOMPARTMENTS C� <br /> ❑ GREASETRAP TVPE/Mro L CAPACm gEl #OP COMPARTMENT$ <br /> ❑ PKG TIE PLANT M6TwHCRTO NEAREaT: WEu. � R FOUNDATION IO R PROPYRTY LINE 7S fl <br /> ❑ LIFT STATION SITE TYPEOP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYRFEM) '1 <br /> Ell LEACH LINES ef LEACHING CHAMBERS #OFLMFs _ LENGTH OF LINES LI07 R <br /> OISrANCETo NEARRRT WELL -(;— FOUNDATION IOJ D PROPERTY LINE SOI B <br /> ❑ FILTER RED WIDTH 6 LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL_ R FOUNDATION ft PROPERTY LINE N <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH It <br /> IASTAIN.-E TO NEAREST WELL ft FDUNDATWN ft PROPERTY LINE R n <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH II <br /> DISTARLi TO NEAREST WELL _ft FOUNDATION_ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS W.. ft LENOTR 9 DEPTH It <br /> DMTANCETo NEAREST WELL R FOUDR PPROPRLINE <br /> 12 SEEPAGE PITS WITH 3(v" D SIMMONS. Z GT <br /> DMTANCCTONRAREST WELL ST FO � ftROFERTYLINE RR <br /> 0 R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M INIMUGN M HOUR ADVANCE NOTICE REQUIRED FOR INSPECPIONS-PLEASE CAIA-(209)9t3-7697 <br /> SIGNED TITLE �u_ DATE V"e ILI to i <br /> .41 <br /> J I <br /> iM '• -H 'E <br /> DEPARTMENT USE ONLY .. <br /> ApplicMM.AT By """`• 14y +Vt DML ( _i '-! i Arca EmybY«IDq_.' %1•k'+ <br /> PiNel lm TmO BT DRI. .7 13SPECI PERMIT-AppmvWNy <br /> CNRndeTo 9De h9f3FG Pit/SumP$DIIC rgTHr = Tz <br /> COMMENTS <br /> .moo <br /> PE SC ReadeW Amount D to Permit/ Invoice# Permit IDS <br /> CWe INro Cvrh RemIRW <br /> 2 L 7.0 1 <br /> H'PI-001 ONSOE WASTEWATER PERMIT <br /> INp2 <br />