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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 /> 1 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 10219 Small rd. CITY/ p Manteca,CA 95336 <br /> CROSS STREET APry ' <br /> ,T^ y� PARCEL SIZE � e <br /> OWNER NAME •` ,` PHONE <br /> �dO K 3 Lam-C��,� A41{J CITY/STATE/ZIP <br /> OWNER ADDRESS C CAA <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATEIZIP Manteca,CA 95336 <br /> LICENSE IIEC-42 71]C-36 OTHERA 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 W REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ] REPLACEMENT D OUT-OF-SERVICE SEPTIC SYSTEM .. DESTRUCTION <br /> INSTALLATION WILL SERVE VRESIDENcE ] COMMERCIAL ] OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: <br /> L3 SEPTICTANK 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 It <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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINEft <br /> FILTER BED WIDTH 12 ft LENGTH 20 ft DEPTH 181, ft <br /> DISTANCE TO NEAREST WELL 100+ fl FOUNDATION 25 ft PROPERTY LINE 30' ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <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, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM48 HOUR ADVANCE NOTICEREQUIRED FOR INSPECTIONS-PLEASE CALL -769 <br /> SIGNED Mike Fuller TITLE Contractor DATE <br /> FC r <br /> E�VED <br /> `� t 5 2020 <br /> A4U/N SOU <br /> 37 �p pART NTy <br /> PARTMENT US^ NLY <br /> Application AcceptedDate Z`� Area ( Employee ID# <br /> Final Inspection By Dat ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil toe^pt-h'of^3 Ft: PiVSump Soil Character: <br /> COMMEN S I `Zr M <br /> i (12--F4 by a I -(- <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cash Remitted Service Re uest# <br /> 25�� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />