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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 24169 N Homestead Lane CrrY/ZIP Acampo,95220 <br /> CROSS STREET E.Jahant Road APN 007-400-62 PARCEL SIZE 5.0 acres <br /> b <br /> OWNER NAME Rosa Cardenas PHONE <br /> OWNER ADDRESS CITY/STATE21P <br /> CONTRACTOR Petralogix Engineering,Inc PHONE 209-770-0731 <br /> CONTRACTOR ADDRESS 26675 Bruella Road CITY/8TATEIZIP Galt,CA 95632 <br /> LICENSE ❑OC-42 0I1C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: >100 feet bgs It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> v PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION I i REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: J RESIDENCE U COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gat #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 O PKGTXPLANT (3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION_---ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ff FOUNDATION 1f PROPERTY I INF 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> is <br /> f <br /> V -o- t IP ISD <br /> Note No well Installed <br /> at time of pert testingV <br /> �I sf '; ;a wII��M�• .-.moi <br /> • PercHole Location <br /> N,«, <br /> Proposed Residenceew <br /> I � R <br /> alp <br /> �p <br /> n ARTMENT USE ONLY <br /> Application Accepted qxDate () Area Employee ID# <br /> Final Inspection By Date 2 bio L SP IAL PERMIT-Approved by •Tr <br /> Characterof Soil to De th of 3 Ft: Pit/Sump Soil Character: <br /> COMM TS <br /> PiYZ p <br /> JOA <br /> PE SC Received Check#/ Amount Date Pennd/ Invoice# N <br /> Code INFO 8 Cash Remitted Service Re uest# <br /> rs�'L 11 120154 \ 0 TM NT <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />