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t ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 9382 E.State Hwy 12 CITY/ZIP Lodi,CA 95240 rn <br /> �i <br /> CROSS STREET N.Locust Tree Road APN 051-120-57 PARCEL SIZE 14.6 AC e <br /> 0 <br /> OWNER NAME Ella Walkers N� PHONE <br /> OWNER ADDRESS %{SM CITY/STATE21P <br /> CONTRACTOR Dillon 8 Murphy PHONE 209-334-6613 <br /> CONTRACTOR ADDRESS 847 N.Cluff Ave.,Suite A2 CIN/STATE/ZIP Lodi,CA 95240 <br /> LICENSE ❑-iC-42 ❑ IC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> xJ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 7 NEW INSTALLATION F- REPAIR/ADDITION rl ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft q'I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft RFcFMFNr <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft V`N <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE 4 Li A•ic UA, <br /> Ell DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DE �44 Y�, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MFNT <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED_ ry-,.iC— TITLE STAFF DATE O�11'41 ZO i <br /> D PARTME <br /> Application Accepted Byte Area Employee ID#� <br /> Final Inspection By Date ❑ S ALUMIT-Approved by <br /> Character of Soil to Depth of 3 PiVSump Soil haracter: <br /> COMMENTS I / <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code <br /> INFO ash Remitted Service Re uest# <br /> 2-4- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />