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�r <br /> 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)L 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS -40W-CarroltonRd `�3 �S ��1/O 7 Q CITY/ZIP Escalon rn <br /> I �,�/1O7 IS-� =1 <br /> CROSS STREET DoodS APN �O5r/'^ O', PARCEL SIZE '�a'� Q <br /> O <br /> OWNER NAME Joey Vander Schaaf PHONE 209-480-3391 <br /> H <br /> OWNER ADDRESS 13749 Murphy Rd CITY/STATE/ZIP Escalon,Ca 95320 <br /> CONTRACTOR Modesto Sand and Gravel,Inc. PHONE 209-545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STATE/ZIP Modesto,Ca 95358 <br /> LICENSE DOC-42 ❑❑C-36 OTHER C-21 NUMBER 271166 EXPIRATION DATE 2/21 <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 7 ENGINEER DESIGNED/ALTERNATIVE <br /> n REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION Septic Tank <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft /1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft PA <br /> V`C•,` <br /> Ll FILTER BED WIDTH ft LENGTH ft DEPTH ft ' �^I► <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE O <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It A� O <br /> A <br /> DISTANCE TO NEAREST WELL ft ft /'FOUNDATION ft PROPERTY LINE SdA20� <br /> L3 SUMPS WIDTH ft LENGTH ft DEPTH ►ft v <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4Q(/IN <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH E/4/f>j O/yMECOUNTY <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DEP'4 V 7-AL <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft MENT <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 /> INIMUM 4 HOUU ADVANQE NOTICE REGURED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED JL— TITLE Project Manager DATE 04/06/20 <br /> III IF III IiIIA I <br /> Ai" <br /> J <br /> 77 <br /> / 2 DEPARTMENTD ? E ONLY <br /> OZD Area y 9 Employee ID# <br /> Application Accepted By 14 <br /> Final Inspection By Date/OJ&40 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Bain to be rkyno jli r? ' , 6a ,1A hL6b" / 10 �r R4�c�-moi t <br /> PE SC Received heck#/ Amount Date Perm ltl Invoice# Permit ID# <br /> Code INFO Remitted Service Request# <br /> E <br /> is1MV 11.5-' <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />