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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4663420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 10351 East Acampo Road CITY/ZIP Acampo/95220 n <br /> a <br /> �e <br /> CROSS STREET Bruella Road APN 017-180-10, 017-260-17 PARCEL SIZE 95.4 Ac. <br /> O <br /> OWNER NAME Bret Lagorio PHONE 209-351-1220 <br /> H <br /> OWNER ADDRESS 16600 Tobacco Road CITY/STATEIZIP Linden,CA./95236 <br /> CONTRACTOR Dillon&Murphy PHONE 209-334-6613 <br /> CONTRACTOR ADDRESS P.O.Box 2180 CITYISTATE/ZJP LodUCa./95240 <br /> LICENSE ❑LC-42 Cl--C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION#PA-1800170 <br /> TYPE OF WORK: L NEW INSTALLATION I 1 REPAIR/ADDITION Li ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT Li OUT-OF-SERVICE SEPTIC SYSTEM ❑ 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES L LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> MINIMUM 48 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 953-7697 <br /> SIGNED TITLE Civil Engineer DATE 3-18-19 <br /> I <br /> 1F,o�T,�oGN�Y <br /> _ AGMPO FOAO t <br /> D ARTMENT USE O LY G�y%� ��� �1`C`� <br /> Application Accepted y Date me Employee A _ITT' Employee ID#—� '� <br /> Final Inspection By Date �'� ❑ SPECIAL PERMIT-Approved by <br /> Character of SoU to DDt th of 3 t. kISump Soil <br /> _ Character: <br /> "IQ � 7p h Y 0 rh"h/n(h C,4)V�9 <br /> PE Sc Received Ch Amount Permitt <br /> Code INFO B ash Remitted Date Service Re uest# Invoice# Permit ID# <br /> Z Z Q <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />