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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 21379 N.Mann Road CITYmP Acampo/95220 <br /> CROSS STREET Acampo Road APN 017-280-09 PARCELSIZE 10.05 Ac- <br /> v <br /> A <br /> OWNER NAME Brent Workman PHONE (209)810-4521 <br /> OWNER ADDRESS 21379 N.Mann Road CITY/STATE/ZIP Acampo/CA/95220 <br /> CONTRACTOR Dillon&Murphy PHONE (209)334-6613 <br /> CONTRACTOR ADDRESS P.O.BOX 2180 CITY/STATE/ZIP Lodi/CA/95241 <br /> LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 7t PERC TEST # 2 FiUlLDING PERMIT# LAND USE APPLICATION# Pa-1700251 <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE :1 COMMERCIAL :1 OTHER <br /> NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gel #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft 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 WELLit FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLit FOUNDATION ft PROPERTY UNE it <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY UNE it <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY UNE It <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELLft FOUNDATION it PROPERTY UNE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY UNE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE NTH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 DVANCE -R U1RED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Party Chief DATE 2-8-18 <br /> P rc Holl P rc Hol <br /> PAYME <br /> RECEIV <br /> o -0 15 <br /> S ERONN) <br /> NEAITH DEPA b P A R T M N U I o v <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection ey L C Date Z f� SPEC ALP MIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS L04 1 R er C- '10XI271 2 50,1 2 = 2 ftrta iln <br /> Lak 2 pe`c lbx li — 1 i 3o/i•z <br /> PE Sc Receive Ch Amount DatePertnfU Invoice# Permit IDN <br /> Code INFO Cash Remitted Service Ra uest# <br /> (� 1/ <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24112 <br />