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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 2380 S. Macarthur Dr CITY/Zip Tracy 2 <br /> r t* <br /> CROSS STREET VBIPICO ApN 252-050-07 PARCEL SIZE %L!L <br /> C <br /> OWNER NAME Emad Basma&Nazar Lobna PHONE 209-914-4751 <br /> OWNER ADDRESS 2380 S. Macarthur Dr CITY/STATE/ZIP Tracy,CA.95376 <br /> CONTRACTOR Plumb1 Plumbing/Dan Kuehn PHONE 209-404-8838 <br /> CONTRACTOR ADDRESS 9741 Wamble Rd N. CITY/STATE/ZIP Oakdale CA. <br /> LICENSE r--- C-42 �/C-36 'OTHER NUMBER 850085 EXPIRATION DATE 11/20 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> 1 <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION 6l ll K_ <br /> INSTALLATION WILL SERVE: YK 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <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 ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER <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 /> ........"O'UR 412VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769,07 <br /> SIGNED TITLE�L / DATE <br /> T <br /> U On <br /> O <br /> p C <br /> A C <br /> T <br /> f ,/`' DEPARTMENT U E ONLY <br /> Application Accepted By L �v'"� Date t s-dO,�o Area Employee ID# <br /> Final Inspection By Date 620 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D pth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS jfoy nF-Jj'% 1p citZ Sewer <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01 / ! /���� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> // <br /> 4/14/18 L0/[ <br />