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SANJOAQUINCOUNTYENONSITE WASTEWATER TREATMENT SYSVIRONMENTAL HEALTH DEPARTMENT 600 E TEM AIN EPERMIT <br /> DNcAs52o2-(209)468J42o <br /> NON-REFUNDABLE PERMIT J� CALL <br /> 209 953-7697 FOR INSPECTIONS E%PIIRrES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 303 S' J2EID PWj - Cramp LI✓D&/v A5 � <br /> CROSS STREET t_O PPEPZ-O PO L-1 S APN 113 -3&o - PARCEL SIZE IS ' a <br /> OWNER NAME JoSt PM r/r A-9-T1^ c.Z PHONE -/V3• ,r '1 • 1 <br /> OWNER ADDRESS 10O4 57tE9-wuy1> 4-/1 • CITY/STATE/ZIP -SA"rrA /QWA,CA ?S-TD <br /> CONTRACTOR L-4VE1ORIL C7 -&J✓j"A-$t"E-k 7-AL- PHONE 369- ©34� // <br /> CONTRACTOR ADDRESS ,T0T lam.!' O R"K C7`' CITYISTATE/ZIP 1-��I (:::-A 9s Z��To <br /> LICENSE JC-42 ,,C-M OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> F�( PERC TEST Il L1L BUILDING PERMIT#_ LAND USE APPLICATION# A-1 GG 3-Sn <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION .. ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: - RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ILEACHING CHAMBERS AOF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE It <br /> ❑ SUMPS WIDTH it LENGTH fl DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER VADTN ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Ir.INIM/�J�M���HOUR ADVANCE NOTICE REQUIRED FCR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /- '� TITLE GO'Nsvl-TA.�r DATE <br /> i <br /> No <br /> A � <br /> _ •� iew�oae (I LLI `� v <br /> rr w Atli y�"Lu Q0Qz <br /> Z y� <br /> �l•IMCaZ � Ik I\ aAcaee.' i ar e. Fat ��( Q �C� <br /> \\ '7 <br /> 'law s { w <br /> a _ <br /> ntorA►erAuc T——— nNeTwwTe rdAv�LAI! �:,• <br /> DEPARTMENT USE ONLY <br /> Application Acce Date a)-15- Area 0 Lf <br /> Employee IDA <br /> Final Inspectlon Date 3 SPECIAL PERMIT•Approved DY <br /> Character of Soil to pth o13 Ft: PIHSump Soil Character. <br /> COMMENTS / <br /> PE SC Receivedh Amount Date Permit/ Invoke M Permit IDM <br /> Code INFO B Cash Remitted Service Re uest/ <br /> 42-M ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />