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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 23555 N.GRAHAM ROAD CITY/ZIP ACAMPO <br /> m <br /> CROSS STREET JAHANT ,,MM APN 007-270-49 PARCEL SIZE 4.88 p <br /> OWNER NAME W I I)SCIM� --yo-1-boa r-J"r A II /� PHONE <br /> f'1 <br /> OWNER ADDRESS ��a�!� t'I • RC) CITY/STATE/ZIP compgTgS J Ot Q <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-269-8586 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/ZIP LODI CA 95240 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> g PERC TEST #3 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION 7 ENGINEER DESIGNED/ALTERNATIVE <br /> n REPLACEMENT rl OUT-OF-SERVICE SEPTIC SYSTEM 7 DESTRUCTION <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 /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft 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 LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft 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 Woods.Tamara oe.'« "a:°°K"°'�"K TITLE STAFF SCIENTIST DATE 5-29-20 <br /> AqY <br /> RF�F�FHr <br /> O <br /> p SF <br /> cc�NpY <br /> DEPARTMENT USE ONLY 1D/y <br /> Application Accepted B �� Date LO— Area Employee ID# <br /> Final Inspection By Date 5 ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PWISum Soil Ch racter: <br /> COMMENTS A I r Z C� "r <br /> C' O wA s . <br /> PE SC Received I Check#/ Amount Permit/ <br /> Code INFO ash Remitted Date Service a uest# Invoice# Permit ID# <br /> qj,aj 5,23 L, a__ Ns� 9-() <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/1e lob&. 770 <br />