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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVDRONMENTAL HEALTH DEPARTMENT 1868 E.HA2ELTGN AVENUE-STOCKTON CA 95205.(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 09 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 9296 E.State Highway 12 CITYf71P Lodi/95240 <br /> CROSS STREET <br /> Locust Tree APN 051-120-56 PARCEL SUE 13.2 Ac. <br /> OWNER NAME Chris S Diane Knoll PHONE(209)334-0450 <br /> OWNER ADDRESS 9296 E.State Highway 12 CRY/STATE21P Lodi/CA/95240 <br /> CONTRACTOR Dillon&Murphy PHONE(209)334-6613 <br /> CONTRACTOR ADDRESS P.O.Box 2180 CrryISTATEILP Lodi/CA 195240 <br /> LICENSE ❑OC42 ❑LIC-36 OTHER NUMBER EXPIRATIONDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST M a i EUILOINO PERMIT# LAND USE APPLICATION#PA iSCOW <br /> TYPE OF WORK: 0 NEW INSTALLATION LI REPAIR/ADDITION L ENGINEER DESIGNED IALTERNATNE <br /> ❑ REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LANG UNIT$: NUMBER OF BECROCIMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DIsTANCETONEAREST: WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPT It <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPT ft <br /> WELL_ <br /> DISTANCE TO NEAREST It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPT ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WEL. R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TMS 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 8 ADV Fog INSPECTIONS-P S CA 09 953-7697 <br /> SIGNED TITLE PartyChief DATE 9-11-18 <br /> All. l9Fdw ® A," <br /> y <br /> 41 <br /> NWO'A' <br /> � FM,°qQ� X01 <br /> DEPARrMEN USE OI,`/ �FaQFNp�N <br /> Application Accepted �/ Date fNLY Area Employee ID# �^'L <br /> Final Inspection ByData,' ❑ SPECIAL PERMIT-Approved by N� <br /> Character of Soll to epth of 3 Ft:' Pit/Sump Soil Character: <br /> COMMENTS 7 U - ! Zo LP fit <br /> PE SC Received haciW Amount Peritl <br /> Code INFO B ash Remitted Data rn <br /> Service Re nest III <br /> Invoice# Permit 19f1 <br /> �Dl2 3 0` <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />