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12- ' 31-bNS[TE WASTEWATER TREATMENT SYSTEM PERMIT /. <br /> v <br /> JOAQUIN COUNTY ENVIRONMI.NTAL HEALTH DEPARTMENT 304 E WEBER Al.IF-3'°FI.-ST(KKTON'CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CC—AI-I.(209)953-7697 EOR I%SPECT IONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 'M 0 1� _ CITY/ZIP _. <br /> JOBADDRESS +y �, 1'q Q � <br /> CROSS STREET _ _ __ APN 0-11- —Z'1 _! �IP RL LL 517.F. � <br /> OWNER NAME PIIONF._ y <br /> OWNER ADDRESS ._ __ _ CITYISTATL/ZIP_. <br /> CONTRACTOR PHONE '%(V <br /> CONTR SCTOR A DDRESS CITY/STAT GZIP <br /> LICENSE ❑C-42 ❑GJ6OTIIFR NUMBER FK I <br /> D <br /> WATER TABLE DEPTH: }i CE(1C.RAPHIC'AL INFORMATION: Coordinates X <br /> FfPERC TEST #_7:?F — 1 BUILDING PERMIT# LAND USE APPLICATION# Y),A 44 _ yid <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ RF.PAIRIADDITION ❑ ENGINEER DESIGNED/AL ATIYE <br /> 7 REPLACEMENT - ❑ DF..STRU(-rION <br /> INSTALLATION WILL SERVE: 1 RFSIDF.NCE ❑ COMMERCIAL ❑ OTHER UJ <br /> NCM8EROFLIYINGUNITS: Nl!MBER OF BEDROOMS: _ NUMRFR bF EMPLOYEES: (� <br /> U SEPTIC TANK TYPe-*MFO CAPACITY gal POFCOMPARFMENTS — "1 <br /> ❑ CREASE TRAP TYPE+MFG CAPACITY _ gal #OF COMPARTMENTS_ <br /> ❑ PKC.TX PLANT DISTANCE To NEAREST: WEI I.— _ 0 FOUNDATION R PROPERTY LIVE ft (�1 <br /> O LIFT STATION SIzE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LlLEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCF.T(IVEARLSF WELL CI FOUVDATION ft PROPERTY LINE ft <br /> 0 FILTER BED WIDTH fl LL?GIH ft DEP71I ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION _ Il PROPERTY Lr4E R <br /> ❑ MOUNDED WIDTH _9 LENG-II R DEPTH :l <br /> DIST'ANC'E 1'O NEAREST %%ELI. fl FOUNDATION R PROPERTY LINF It <br /> ❑ SUMPS WIoTR R LENG7M It DEPTH it <br /> DISTAN('ETO NEARFST WFLL R FOUNDATION R PROPERTY LINE _ft <br /> ❑ DISPOSAL PONDS WtDTR 11 LOGTH ft DEPTII ft <br /> DISTANCE TO NEAREST WELL R FIX NDATKIN R PROPFATY I INF. ft <br /> ❑ SEEPAGE PITS NI114BF.R WIDTH ft DEPTH R <br /> DISTANCF.TO NEAREST WELL ft FOUNDATION f( PROPERTY LINE _ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AVD THF.WORK WILL BE DONE.IN ACCORDANCE WITH SAN JOAQVIN COUNTY <br /> ORDINANCES,STATE LAWS ANP RULES AND REGULATIONS OF SAV JOAQUIN COUNTY. <br /> AUNIMLM 20 HOUR AD.A.''E NO"I-10.REQUIRED FOR INSPECT IONS-PLEASE 41.1611.(2091453-76'17 <br /> SIGNED Mti.. L .. _ TITLE �wS..�1 -z<,,`�•J DATE <br /> r ' <br /> Al I Ll <br /> A 121111 <br /> 1 <br /> I - <br /> i TJ. <br /> _ U <br /> I I <br /> D ARTNIENF I1SE %Ll c�N / <br /> Application Accepted _ Date M11110 Arca Employee IDN <br /> Final inspection By �?(��` a /1 •f O ❑ SPECIAL PERMIT•Approved by 9 <br /> Character of Soil to pth o 3 Ft: t WSump Soil Character: <br /> COMMENTS <br /> /t!�� 2 �'r• r/'P-.ti? n�- �� .>"<_'- � ��✓ i .J-!1-s/s ! lyFj [1 ri �� �-/,- <br /> e, <br /> PE SC Received i Check#k- Ansount Permit! <br /> Code INFO By �>is�i Remitted Date Service Request# invoice# Permit IDN <br /> 42-02-001 ONSITE WASTEWATER PF.kifllf":r"e- <br /> t2•Y2'2(fOJ -1 <br /> -,.:Y'ri <br />