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*03cD 5/ 7 <br /> ONSITE WAST ER TREAT ENT SYSTEM PERMIT 4- <br /> BAN JOAQUIF COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3 EWEBER AYE.3"FL-STOCKI'ON CA 95202- (2O9)<68-M20 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES J� �I YEAR FROM DATE ISSUED <br /> ES <br /> JOBADDRS ' C}TY21P Lndge/ <br /> CROESSTREET /PLG- APN PARCEL SIZE ;2 9 <br /> OWNER NAME C C../LI`' /(I xS I } PHONE 3107- 17010 F <br /> OMNERADINUM Z�OSa JV LSP1 CITYISTATLZH' ��/y)f'J <br /> CONT"cEOR L/UN��'jp� ,^T PHONE � //J0 <br /> CONTRACEORADDRESS / � k`•` CRY'/SSTATMIP <br /> LICES'fE <2 0C-36 ORIER NUMBER GG EXPIRATIONDATE 0-Q / <br /> WATER TABLEDE w R GEOGRAPHICAL INFORMATION: C..rdi..Ul X Y <br /> ❑ PERC TEST(S) NUMDER LAND USE APPLICATION# <br /> TYPE OP WORK: INE.INSTALUTION ❑ REPAIRIADDITION ❑ ENGINEERDESIGNEDIALTER.9ATtVE <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL / C=OTNER <br /> NUMBER OF LIVING UNITS: /O I (' NUMMBEER OF BEDROOMS: Y NUMEfR OFEMPLOYBES: <br /> JC/SEPTIC TANK TNPLWFG anc- �'i//�...J� CAPACITY OO Set #OFCOMPARTMENTS - <br /> ❑ GREASE TRAP TYPFlMFG CAPACITY JtL PI #OF COMPARTMENTS J� <br /> ❑ PKG TX PLANT DISTANCE EO NEAREST: WELL SO I R FOUNDATION Xlf) R PROPERTY LINED' fl <br /> D LIFT STATION Sm TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLosto SYSTEM) <br /> ❑ LEACH LINES a LEACHING CHAMBERS ��i #OF LINES� LENGTH OF LINES <br /> DISTANCETONEAREST WELL /IVC7 It FOUNDATION /O ft PROPERTY LINE_Tl7 R <br /> ❑ FILTERSED WIDTH ft LENGTH R DEPT. ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED W. R LENGTH IT DEPTH ft <br /> DISTANCETONEARE4T WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH fl LENGTH ft DEPTH ft <br /> DISI'ANCETONEARRM WELL R FOUNDATWN ft PROPERTY LINE fl <br /> ZI DISPOSAL PONDS WOrT ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> SEEPAGE PITS W.. 4.0cp-Ai ft LENGTH ft DEPT ia- ft <br /> DISTANCE TO NEAREST WELL L.��ft FOVNOATION LD ft PROPERTY LINE ZG� ft <br /> 1 HEREBY CERTIPY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br /> STATE LAWS AND RULES EGULATIONS OF SAN JOAQUIN COUNTY. <br /> N HH0 ADV OTICE REQUIRED FOR INSPECTIONS-PLEAS�CALL(2W)953-7697 r <br /> SIGNED TITLE DATEmom <br /> 25' PI1f 4 IAD. t'xi same V <br /> 501.46' 44.TY <br /> \ Y <br /> 4.VI <br /> Z <br /> � n a 5 � PAY. <br /> RACE V <br /> 4 I SAN JO <br /> E Ft <br /> HEALTH NT <br /> it <br /> J <br /> / DEPARTMENT USEONLV <br /> AMIIIM onA .!INdB J/I(1/1 { <br /> I DIU / S IS / Ane Y-r Employm <br /> FinRllmpeccbn D.N /-E3 Gf ❑ SPECIAL PERMIT-Appmvd by <br /> Cbaneter RTSBII m W of J Fh N"ump Soil Cbmcter: <br /> COMMENTS <br /> PE 8C Raeived Cbec Amount Permit/ <br /> Code INEO a BEb Remitted to Service R ,unt# invola# PerMt IDp <br /> e3-0I-0DI ONSITE WASTEWATER PERMIT <br /> 12203 <br />