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� 1 <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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 12511 Mundy Lane CmY/ZIP 95240 <br /> CROSS STREET East Hogan Lane APN 061-120-590 PARCEL SIZE 3.03 Y <br /> OWNER NAME Smith Michael M&Beverly J ETAL PHONE 209-467-1006 T <br /> OWNER ADDRESS 12,911 Mundy Lane CITY/STATE/ZIP Lodi,CA 95240 <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800-571-9300 <br /> CONTRACTOR ADDRESS 837 Shaw Road CITY/STATE/Zip Stockton,CA 95215 <br /> supeAsedbyCAftGwlWil - j 01/31/2023 <br /> LICENSE 11--C-42 0--C-36 OTHER NUMBER B�-i,fG4�.�.� ;�� EXPIRATION DATE <br /> WATER TABLE DEPTH: 70-80 feet ft GEOGRAPHICAL INFORMATION: Coordinates X 38.052918 y 121.150562 <br /> PERC TEST #I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: G NEW INSTALLATION _ REPAIR/ADDITION C ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM f 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 /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTYLINE It <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)953-769 7 <br /> SIGNED ` J TITLE Staff Geologist DATE 06/16/2021 <br /> S E E A T T A C H E D <br /> CEENT <br /> V ED <br /> 22 ?021 <br /> R E E r,4 NrY <br /> AR MENT <br /> DEPA R TMENT-USE ONLY ')A <br /> Application Accepted B Date Area y Employee ID# <br /> Final Inspection By Date 7 SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft: Pi SU p Soil Character: <br /> COMMENTS 4XGypl D /'";Wl-iNcz . <br /> PE SC Received Check#/ Amount Permit] Invoice# Permit ID# <br /> Code INFO B ash Remitted Date Service Request# <br /> qP <br /> a 3 's ► � <br /> 42-01 ! ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />