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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2288&2696 N.Murray Road CrrY21P Linden/95236 „ <br /> CROSS STREET Highway 26 ApN 105-100-20,21 PARCEL S 156 Ac.SIZE <br /> O <br /> OWNER NAME Michael Machado PHONE(209)601-5277 <br /> OWNER ADDRESS P-O.Box 555 CT yISTATFJZIP Linden/CA/95236 <br /> CONTRACTOR Dillon&Murphy PHONE(209)334-664 <br /> CONTRACTORADDRESS P-O.Box2180 CITY/STATE/ZIP Lodi/CA/95241 <br /> LJCENSE ❑LC-42 ❑LC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #1 BUILDING PERMIT# LAND USE APPLICATION#PA 1900009 <br /> TYPE OF WORK_ L NEW INSTALLATION J REPAIRIADDrnON _ ENGINEER DESIGNED/ALTERNATIVE <br /> = REPLACEMENT ❑ OUT-OFSERVICE SEPTIC SYSTEM G DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE It <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 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ` <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTYLINE /� Alp <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH30 CO <br /> DISTANCE 70 NEAREST WELL ft FOUNDATION ft PROPERTY LINE 1Q <br /> ❑ SEEPAGE PRS NUMBER WIDTH It DEPTH RQu/,Vc vv <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE NTH SAN JOAQUIN COUNTY ORDINANCES, <br /> WIfP� p.T� <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 'nE/V1- <br /> MIN/MUM 48 HO "B-VANCE NOT UIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Party Chief DATE <br /> 7 TT <br /> DEPARTMENT USE O Ly �y <br /> Application Accepted By Date Area / Employee ID# <br /> Final Inspection By Date E3S IAL PERMIT-Approved by <br /> Character of Soil to DTpth of_3 F�• Pit/Sump Sol[Character. <br /> COMMENTS <br /> PE SC Received Amount Date PermlU Invoice# Permit IN <br /> INFO B Cas Remitted Service Re uest# <br /> 42-01 ONSFFE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />