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ONSITE WASTEWATER TREATMENoT SYSTEM PERMIT <br /> cA 95202 -(zov)468-3420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL 209,1953-7697 FOR INSPECTIONS EXPIRES t YEAR FROM G ATE ISSUED <br /> ?�l�/2 Aifl�/vl 5il CT c1TY/ZJ' e <br /> FADDRM - > <br /> PARCELSIZE c <br /> APN C?(�iPHONE <br /> CITY/STATF/ZIPESS <br /> PHONE S <br /> CONTRACTOR <br /> U <br /> frrvlCTATFI�.IP ,I <br /> CONTRACTOR ADDRESS � <br /> C-36 OTHER NUMBER �, �j y� EXPIRATION DATE <br /> LICENSE -42 ❑ <br /> Y <br /> R GEOGRAPHICAL INFORMATION: Coordinates X <br /> WATER TABLE DEPTH: <br /> �--- <br /> BUILDING PERMIT# —C60rT 8U LAND USE APPLICATION# <br /> ❑ PERC TEST # ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPAIRIADDITION <br /> TYPE OF WORK: NEW."SPALLATION ❑ DESTRUCTION <br /> ❑ REPLACEMENT <br /> INSTALLATION WILL SERVE: E RESIDENC <br /> ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: <br /> `!UMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CAPACITY Sal OF COMPARTMENTS <br /> CC SEPTIC TANK TYPE MFG gal #OF COMPARTMENTS <br /> �— <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY R PROPERTY LME tlr+ R <br /> ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL //U R FOUNDATION /O �•. <br /> TYPE OP PEMP <br /> C3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LIFT STATION SIZE s✓�� Vl <br /> #OF LINES <br /> p' LENGTH OF LINES d-q ft 'L <br /> tLEACH LINES ❑ LEACHING CHAMBERS ft PROPERTY LINE jej it N <br /> DISTANCETO NEAREST WELL // ft FOUNDATION <br /> It DEPTH R <br /> ❑ FILTER BED WIDTH ft LENGTH <br /> C' <br /> ft FOUNDATION ft PROPERTY LINE--_eft <br /> WELL <br /> DISTANCE TO NEAREST ft DEPTH <br /> MOUNDED WIDTH ft <br /> ❑ R LENGTH <br /> R FOUNDATION R PROPERTY LINE <br /> DISTANCE TO NEAREST WELL R <br /> R DEPTH <br /> C3 sumps WIDTH R LENGTH <br /> ft FOUNDATION <br /> R PROPERTY LINE �-- <br /> DISTANCETONEAREST WELL fl DEPTH R R1 <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH <br /> fl FOUNDATION R PROPERTY LINE�� r <br /> ft <br /> DISTANCE TO NEAREST WELL ft DEPTH <br /> SEEPAGE PITS NL'MBLR — WmTM '�/•, --it <br /> R FOUNDATION SA4� ft PROPERTY LINE�J,(�� <br /> DISTANCE TO NEAREST WELL^//-�Cr__ ---�— <br /> I HEREBY CERTIFY THAT i HAVE <br /> ORDINANCES,STATE LAWS AND RULES WITH SAN JOwQUiN COUNTY <br /> RULS AND REGULATIONS OF SAN JOAQUIN COUNTYw <br /> MINIMUM 24 HOUR ADVANCE. REQUIRED FOR INSPECTIONS-PLEASE.CALL(209) 3-7697 <br /> y <br /> TITLE � DATE <br /> SIGNED <br /> iI <br /> EA <br /> H <br /> • <br /> / <br /> - DEPARTMENT U E ONLY Employee 1D# j. �v RG <br /> Date I[ Area 3 <br /> Application Accep Y / ❑ SPECIAL PERMIT-Appro by /t, <br /> Date�— <br /> Final inspection y l� Pit/Sump Soil Character: <br /> CharacterofSoil of Pt: �i�.c�-� <br /> COMMENTS <br /> X <br /> 11-o G� <br /> Received Amount Date Permit/ Invoice# PermltlD# <br /> SC Service R uect# <br /> Code <br /> e Inco B _ <br /> 2.t1 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> 12222003 <br />