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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> BAN JOAQUIN COUNTY ENVIRONMENTAL HE AL iH UE FAR IME-NI 1868 E.HAtFI ION AVENUE-SIOCKION CA 95205-(209)468-3420 <br /> MON-REFUNDABLE PERMIT CALL <br /> 209)953-7697 FOR INSPECTIONS EXPIRES-1 YEAR FROM DATE ISSUED <br /> - -JOB ADDRESS �C.a '�rL __ _ CITYIZIP_,-._-� •.0-�� �..1 �� _ _ <br /> CROSS STRE.F.T �/J� ,,APN Z� w <br /> "1O � •� PARCEL SIZE <br /> OWNFR NAME: `�' , '�` flt� PHONE <br /> OWNER AnvnEss !(�,-_.. CITY/STATEIZIP <br /> CONTRACTOR J_j..jlL✓ ...•yJ^- ��L 9P�.f Ct�C/ PHONE .,_yIrT I -.---_ <br /> CONTRACTOR ADDRESS Y -_F > /'_.^.-�-,. CITY/STATE/ZIP <br /> LICENSE C-A2 C-36 OTHER NUMBER `�J�-.EXPIRATION DATE Lf <br /> WATER TABLE DEPT": It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC'TEST N -� BUILDING PERMIT If LAND USE APPLICATION# _ <br /> TYPEOF WORK: NEWINSTAt.LATION REPAIR/ADOrTION ENGINEERDESIGNED/ALTERNATIVE <br /> REPLACEMENT OUi-OF-SF.RViCE SEPTIC SYSTEM DFSTRUC.TION <br /> INSTALLATION WILL SERVE: RESIDENCE 1A COMMERCIAL OTHER <br /> NUMBER OF LIVING UMTS: NUMBER Lav BEDROOMS: NUMBER OF EMPLOYEES:-� <br /> .J SEPTIC TANK TYPE/MFG 6ILt -_-- CAPACITY _ gal #OF COMPARTMENTS_. <br /> .J GRFASE TRAP TYPE/MFG - CAPACITY gal #OF COMPARTMENTS_ <br /> DISTANCE TO NEARFS'I: WFLL It FOUNDATION I! PI-,F Fir,LINE <br /> J LIFT STATION SIZE __TYPE Of PUMPQ PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEA CHINGCHAMBERS ,. #OF LINES LENGTH OF LINES _ft <br /> DISTANCE TO NEAREST WELL } It FOUNDATION 12A2 -ft PROPERTY LINE <br /> G FILTER BED WIDTH _ If LENGTH ft DEPTH <br /> DISrANCE To NEAREST WELL—R FOUNDATION It PROPERTY LINE ft <br /> :3 MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE_ ft <br /> a SUMPS WIDTH ft LENGTH <br /> *�4�, ft DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION _--It PROPERTY LINE 10, <br /> ft <br /> :3 DISPOSAL PONDS WIDTH _ft LENGTH_ _ft DEPTH,_ It <br /> DISTANCE TO NEAREST WELL, _ It FOUNDATION ft PROPERTY UNE <br /> ;J SEEPAGE PITS NOMeER ----- WIo7H --_-.__—ft DEPTH_-___. ft <br /> DISTANCE TO NFAnFST WELL_ _ ft FOUNDATION ft PROPERTY LINE-._-____ It <br /> I IIEREBY CERTIFY THA?1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> 51 ATF LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE_�,.t-- �`✓i+•}E - _.. DATE <br /> - <br /> O )1'1KC: U C - •t <br /> E VI T< LI �. <br /> c <br /> ISO <br /> � - 7 <br /> i <br /> DFPARTVE#j Y4Fn_NI.V <br /> Apphcation Accepted By/ i�971Ya-- -+Date I Area mS """•w+•-�•�a4n... ,,:.:,,,w. <br /> Final Inspection Byjy,:ylj � Date SPECIAL PERMIT ?:alOve�l e <br /> Character of Soil to DAPth of 3 Ft: __- Pit/Sump Soil Character: <br /> COMMENTS _. Lir IM 14 <br /> ,PIE Sc Rec:elved 1 Checkni Amount Permit/ <br /> Date Invoice M Permit ID# <br /> Code INFO By Cash Remitted _— Service Request A <br /> 1 'L l 235( ,I �L 3 <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4*4112 <br />