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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 <br /> 23485 Hansen rd CITY/LP Tracy,CA <br /> `' n l � <br /> CROSS STREETyi rl k P.C 11PIC' APN d `7 PARCEL SIZE �� o <br /> OWNER NAME <br /> DI�✓I I�Ob I101 4r PHONE <br /> OWNER ADDRESS -SCI rM Q. CITY/STATE/ZIP <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITYISTATE/ZIP Manteca,CA 95336 <br /> LICENSE ❑OC-42 ❑-C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: 3�/ it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#_ LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION Fr REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 7 REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM C DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERRAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> -01"LEACH LINES LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINES 100' ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 30 ft PROPERTY LINE 101 It <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE To NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELL It 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, A,q� <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVMCE OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 953-769 �CF� -Avp <br /> SIGNED J <br /> Mike Fuller TITLE Contractor DATE / � O vz® <br /> qQ41 00 <br /> 20, <br /> SRO "/ <br /> Tye pgRNT°,q�N�Y <br /> MFNT <br /> DESE ONLY <br /> Application Accepted By Date /'o Ij D,,4 t7 Area Lr C Employee ID#_ _ <br /> Final Inspection By Date' ZO [I SPECIAL PERMIT-Approved by <br /> Character of Sol,to Deof 3 Ft: Pi ump Soil Character: <br /> COMMENTS F'tpl QIP 6�- Imp!, I Pl <br /> PE SC Received Che Amount Date Perm"' Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> yai� ris _ 3vo •r�-Zt) <br /> 44-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />