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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 20764 Hansen Rd. CITy/ZIp Tracy,CA Z' <br /> CROSS STREET Byron Rd. APN Q709/8C>1?' PARCEL SIZE <br /> OWNER NAMEL✓` / L II--C- ll nY'C f�A G' 1 PHONE ��J <br /> OWNER ADDRESS S�-✓� P-d CITYISTATEIZIP TrG g .4q /`S3 O <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATEIZIP Manteca,CA 95336 <br /> LICENSE -C42 --C-36 OTHER A NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> - PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: - NEW INSTALLATION REPAIR/ADDITION - ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT - OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 7 OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:2 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 fl 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 1 LENGTH OF LINES 100' ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 10' ft PROPERTY LINE 10 ft <br /> ❑ FILTER BED WIDTH 1`1 LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ SUMPS WIDTH fl LENGTH fl DEPTH fl <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH fl 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 Mike Fuller TITLE Contractor DATE <br /> 4(r <br /> O <br /> ������ DEPARTMENT US ONLY _ qR 44 <br /> Application Accepted By Date 16 0 0 Area s �/ Employee ID#_� F <br /> Final Inspection By Date 71 SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft: Pit/S mp Soil Character: <br /> COMMENTS Fc dui lr' O W P :ZPY <br /> PE SC Received eck# Amount Date Permit/ Permit Permit ID# <br /> Code INFO B Remitted Service Request# <br /> ala 1 -1 00 —17 00 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />