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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUMCOuMENVOKINMENTALHEALTN DEPARTMENT 301E WEBFR AVE-3'Fl,-ST(10ETON CA 95202-(20)4M-3420 <br /> NON-REFUNDABLE PERMIT CALL(109)953-7697 FOR INSPECTK)NN EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDR¢5 016L4,1 lclrtrv1L, No CRY21P <br /> LW <br /> CROS,STREET APH 190 PAR('ELLSIEE ��`�✓T"�� IpO, <br /> OWNERNAME //��I / _ ',4�� PP,.'NNiL 47/-77 — AJ',c I U <br /> OWNERAWSUIS "H\ ��FlII. ��y\n 1✓l]omn .EO�I(}�e.♦..� CIT/STATE LIP .�IL(.II �F+'.T I.1T/�)�q O'�)O <br /> CONERACTUR A�Ii, L�,1.1 0 1Np(lCp"\ V As—<z*.. PROVE(�„ b ( l�✓/ `) <br /> CONTNACIORA.DR ESS rW� ^ �LN� A CT'/STATFJZIP CUd7 RA E� <br /> LICENSE 0C4 0C-35 OHIER NLNIBEP C57 ENPIRATION DATE u�0 <br /> WATER TARLE DEPIYI: H GEOCMNIIC'ALINPOMIATION: CunrJinale5 X 1' <br /> PERC LEST(5) NUMBEM1 R LAND USE APPIJCATInNR L <br /> T\ EOF N'ORK: O NEWINETALLATON ❑ RIO.RJA.MDON ❑ ENEINEERD¢MCNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DELERDC.TION D <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL LlOTHER <br /> NNNEEROF LI\INC UNITS: N OMBER(IF BEDROOMS: NUMBER OF EMPLOS'EES: <br /> ❑ SEPTICTANK TYPEIMPO__ CAPACITv Ral 0NlCOMPARTMEMS <br /> ❑ CREASE TRAP TYPEIMFG CAPACm SW N01COMPARTNENT9 <br /> ❑ PKG TE PLANT B15TANCETONCARESE: WELL 0 FOUNUATKIN S PKOPERIf LINE 6 <br /> ❑ LIFTSTATION Suc TvEEDEPUMP Cl SAND OIL SEPARATOR IENCLEDROSVETEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHANIBERS kOF LNES _ LEN'OTIIOILLVEt ft <br /> DISTANCE TO NEARESE WELL R FWNOATWN R PROPERTY LINE Tl <br /> ❑ FILTERBED WINES R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R PTUNOATION R PROPERTY LINE N <br /> ❑ MOUNDED W... ft LENDER_- ft DEPTH R <br /> DIETANCETONEAREPT WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS W... ft LENDIR R DEPTH fl <br /> DISTANCETONEARPST WELL ft FOUNDATION—11 PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIRER A LENEDS A DEPT. R <br /> DRTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R MrEn R <br /> DISTANCETONEAREST WELL 11 POUNDATION R PROPERTY ONE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN AAQUIN CDUPF ORDINANCE$ <br /> STATE LAWSAND RVLES AND REGUTA'DONS OF SAN MAWIN COUNTY. <br /> �, 1 <br /> MINIMUM NIMU DA'BYNCE NOTICE REQUIRED FOR INSPECTIONS-PyLIA�SE CAIAIE091'P3-7SQ7 ^� <br /> SIGNEDO,/�/N-/ �L�9"'1 TITLE ��A11 DATE <br /> .111 7 Ira,G <br /> UN;rI•._ <br /> DEPARTMENT US¢ONLY —1 <br /> AppilEMlon A.PpIN BY Dam 1 -Q 3 Arc+ L Empbya IDR= _ <br /> Plmllmpae[Ioo BY Dme ❑ SPECIAL PERMIT-Aypmv97 by <br /> CM1anEterof S011laM hof3FC NUSunp Soil Charamer: <br /> COMMENTS O <br /> D .4 . Ger/tr <br /> aft47^ee�A* <br /> d <br /> PESC RtteNeO ttkX/ AmouRl Dah Perm.. iprolttN Permit lDp <br /> Code IS. RRmIRRO ServIReR ue <br /> N 34 11 <br /> L'L'L 92 W-1 <br /> .2AI.l ONSITE WASTEWATER PERMIT <br /> ILLO: <br />