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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGWN COUNTY ENNRONM ENTAL HEALTH DEPARTMENT 1668 E.H►ZELTON AVENUE-STOCKTON CA 95205-D209I 468-120 <br /> NON-REFUNDABLE PERMIT CALL 9 952-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 11808 N-Ham Ln- CITy0p Lodi 95240 <br /> CROW STREET Armstrong APN 050-230-12 PARCEL Sfg 0.98 AO. v <br /> a <br /> DINNER NAME Roert Englent PHONE(209)993--5549 <br /> OWNER ADDRESS 5amB LITYISTATEMP t• 4�Z <br /> CONTRACTOR Lire Oak GeDEnwonmental PHONE(209)369-0375 <br /> CONTRACTOR ADDRESS 407 W-Oak St. CfrYfSTATErmp Lodi,CA 95240 <br /> LICENSE 11CC42 ❑CC36 OTIERCEG NUMBER 2151 ExPIRATTONDATE 460126 <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFO"ATIoN: Coordinates X Y <br /> ; PERC TEST # T I BUILDING PERMIT* LAND USE APPLICATION# <br /> TYPEOFWORK-- C NEW INSTALLATIOR L' i&iwRYADDmGN .- ENGINEER DESIGNED IALTERNATLVE <br /> REPLACEMENT C Otrr-0F.SEMACE SEPTIC SYSTEM ❑ DE.STRUC710N <br /> INS TALLATION WI LL SERVE: ❑ RESIDENCE 1) COMMERCIAL p OTHER <br /> NUMBER OF LIIIIMG UNITS: NUMBER OF BEDROOMS' NUM BER OF EMPLOYEES: <br /> ❑ 5EPTICTANK TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPAOTY gat /Of COMPARTMENTS <br /> DISTANCE To NEAREST- WELL R FOUNDATION ft PROPERTYLJNE ft <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP O PKGTAPLANT L] SAND OIL SEPARATORtENCLOSFED SYSTEM] <br /> ❑ LEACHLINES n LEACHING CHAMBERS SOFUNrs LENGTH OFIaNEs It <br /> DISTANCE TO NEAREST WELL fe FOUNDAT1ON R PROPERTY LINE ft <br /> (3 FILTER BED WEOTH ft LENGTH ft DEPTH it <br /> DISTANCE To NFARFsT WELL ft FOQK)ATON ft PROPERTY LINE R <br /> ❑ MOUNDED WnTN R LeNGTH ft DEPTH tt <br /> INSTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS Wd7H 2 LENGTH ft DEETH ft <br /> DISTANCE TO NEAREST NIFEA ft FOTNwgATK)N ft PROPERTY UNE ft <br /> L] DISPOSALPOND.4 WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPFRTYLINE ft <br /> (3 SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL it FouNruTON ft PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT 1 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 /> MINIM M 4 ADVANC_AQTICE REQUIRED FOR IN P N -ft EASE SE CALL 09 953-71697 <br /> SIGNED TITLE Project Manager DATE 1- 2-f-Z�� <br /> ,s <br /> -- j <br /> - ------ ------• J <br /> .... pAYMENT <br /> DEP RTME T EON Y ■f <br /> Application Accepted By ' Date , Area Employee IDO /A•&J ECE■VEL) <br /> Fina t I nspection By Date ❑ SPECIAL PERMIT-Approved6 <br /> Character of Soil to Depth Of3 Ft: PIt1SUMP Soil Character: <br /> �AH z 9 zozs <br /> COMMENTS <br /> A4U►N COUNTY <br /> NQNMEN7AL <br /> PE Sc Received Chec Amount DatePemIW Invaicer PemlitlD# DEFA12'�EN.r. <br /> Code Iwo B Remittetl Service uest# <br /> Il// !7 AdCa •,� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114AS <br />