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T <br /> • °L ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> RAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SDI EWUSER,AVE-Sv°FI.-SROC ETON CA 91202-(209)468-JIM <br /> NON-REFUNDABLE PERMIT CALL(209)9SX7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDR[SS 7-42 G CIu, <br /> A y <br /> 1 <br /> CaORS.SIAEEf S�,fT 1 (2 AP\N OAS-/DO-S�J� PA�RpCEL�BjD�[Q 2japL.n s Lia 1y°� <br /> OW'NERNAML �l �I f�U'C-F (1'��.�J�� <br /> OWNER ADDRESS ' 137 W.J�n/F'2O YM� /',Ea Je. Cm�/S[ATE/ZD (&9J-,-L7-370I <br /> yCJ7 -J�I�ZO� <br /> CONSMCIOR IV�II��OS .P9/A/I//!'GJ A�'SSAoG.��E PRONE(&9J—,II7-J701 <br /> CONEMCTIIN ADDRESS LL FICCJSTW LhT�ad CITY/SFA'N'zur <br /> LCCEE 0 C4 0C-3. OTU. NDMBE0. IvC95'zl yo <br /> 'T 0 <br /> N'ATENTA.LEDEPEN: w A GIWCRAIDDI Al I.JFORMATON: C°oE i.11lH R Y <br /> 1)4 PERCTEST(S) NUNOER LAND USE APPLICAL(M0 AQ A/13 <br /> TYPE OF WORN: ❑ NEN'IRITAL1AT10N ❑ NEPAIN/A.PTION ❑ ENGINEVIDUR.RED/ALTENNATII'E <br /> ❑ REPLACEMENT O DEST0.0CEION <br /> INSTALLATIONS"ILLSERFE: 13RESIBENCE C3C,NODH.AL (3DINER <br /> NUMBERM LIVING UNRS: NCMBILNOFBEDROOVS: NL'MSEROFEMPLOYEES: <br /> Cl SEPTICTANK TYEVMfa CAPACITY 11 N OFCUMPARTMESTS _ <br /> ❑ GREASETRAP TYK/MFG __ CAPACITY_ PI NOFCOMPARTMENTS <br /> ❑ PKC TR PLANT DISTANCETONEARFST: WELL It FUTINDAT.. 11 P.o,,E,'LIKE D <br /> ❑ LIPT STATION SUE T'NEOEPuMP ❑ SAND OIL SEPARATOR(ENCLOSEDSVs EM) <br /> ❑ LEACM LINES ❑ LEACHING CHAMBERS_ NOF LIMES LENGTN OF Ln[s D <br /> DLSfANCETONEARISr WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED NO.. R IENOTN It DEPT fl <br /> DLRANCETONE.ARE.ST WELL A FOUNDATMN ft PRWERTY LME H <br /> ❑ MOUNDED x'loix 11 LENDER fl DEPTH fl <br /> DISEANCETO NEAREST WELL ft FWNDATMN R PROPERTY LINE fl <br /> ❑ SUMPS WLTII R LENGTH R DEPIN 0 <br /> DIBEANCETONEAREST WELL fl FOUNDATWN B PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS M'NO R LENGTH fl DEPT ft <br /> DISTANCETONWRE4T WELL ft FOUNDADDINR PRODEETY LINE D <br /> ❑ SEEPAGE PIPS WIDTH R LENGTH R DEPT fl <br /> DLSTANCETONEARESE WELL D FOUNDATION fl PROERT'LINE fl <br /> 1 HEREBY CE.RTIFSTHAT"1"AVE PREPARED THIS APPLICATION AND THE WORN WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQLHN COONT'. <br /> NIMU Y31 NOUN ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> --PLEASE CALL J100)913407SIGNED TITLE /-/O,CGT /TblHbW GATE O <br /> + a§ <br /> "i alfa a - <br /> [3 a A§ sj <br /> • R <br /> EF > <br /> + ® ❑ s v <br /> „ �x <br /> t -- <br /> DEPARTMEN U O Y <br /> APDERRIIon AETepled B - DRIR Arm .?u. EmpD° IDN <br /> FIRM ODPSEd..By DRI,_ ❑ SPECIAL PERMIT-Appmvd by / <br /> Ch.-der afS.R U,Dep Df3 FI: PWSump ScAl CB.md.r: <br /> COMMENTS ?E /Z6 Ki eaaur6Y...217 AL�JJw /—y.e.Zert>c�A>rs�T.csl� i1+9/-N� <br /> T3'477 e r ) Et/icldA 4S o Sze ��;fL'+P� �a car7vl-a�J L eh.ddL.NZGr's t-st2 <br /> PE SC R-1 Id CIMe Amount Dale PermfU l.volmp Perm111Dp <br /> Cade lero By R-e-mT llTetl ^ SerVIS, oeO0 <br /> / <br /> 4-0I <br /> Ii2/OJ ONSITE WASTEWATER PERMIT <br />