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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOWN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE-STOCKTON CA SS205-(209)468,l20 <br /> NON-REFUNDABLE PERMIT CALL 09 953-7697 FORINSPEcnoivs EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4440 E.Cherokee Rd. CITy/ZP SLOGktpn,CA 95215 <br /> CROSS STREET Hubbard APN 087-090.02 <br /> PAR[xl SIZE C <br /> C/O Octavio Medina e <br /> °"""�NAMEEPHONE(nos)470-9026 <br /> OWNER ADDRESS 6156 E.Ashley Ln. + <br /> GTyISTATEIZIP 57DL -1-r,:� Gh G'I� 21z <br /> CONTRACTOR Live Oak GeOEnvironm aul PHONE (209)369-0375 , <br /> CONTRACTOR ADDRESS 407 W.Oak St CiTYISTATFILp Lodi,CA 95240 <br /> LIcENsF ©DC-42 0:1C38 OTHER CEG NUMBER 2151 <br /> EI[PIRATION DATE 4r30128 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL I NFORMATION: Coordinates x Y <br /> PERC TEST # BUILDING PERMIT* LAND USE APPLICATION It <br /> TYPE OF WORK: :_ wEw IAISTALLATION ❑ REPA/W��ADDInON ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT ❑ CUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INS TALLATION WILL SERVE: {] RESIDENCE ❑ COMMERCIAL ❑VOTFER <br /> NUMBER OF LIVING 11NrrS• NUMBER OF BEDROOMS; NUMBER OF EMPLOYEES: <br /> d SEPTIC TANK TYPEIMFG CAPAGTY gal #DF GoNIPARTMENTS <br /> f, GREASE TRAP TYPEIMFG CAPACITY gal B OF COMPARTMENTS <br /> DISTANCE TO NEAREST. WELT It FOUNDATION tt PROPERTY LINE ft <br /> 0 LIFT STATION S17E TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR[ENCLOSED SYSTEM] <br /> LEACH LINES - LEACHING CHAMBERS OOP LINES LENGTH OF LINES {t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LJNE ft <br /> Q FILTER BE I) WIDTHft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> LI MOUNDED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LJNE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 11 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH. ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST Vil UU ft FOUNDATION ft PROPERTY LINE It <br /> 0 SEEPAGE PITS NUMBER WIDTH R DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY UNE ft <br /> I HEREBY CERTIFY THAT l HAVE PREPARED THIS APPLICATION AND THE WORK MILL eE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM ICE R UIR ❑FOR INSPE ON - SF CALL 209 953-7 <br /> SIGN€D <br /> TITLE Project Manager DATE --r r it_2,(e <br /> I F # -- --------------- <br /> ----------------- <br /> ------------------ ----- <br /> ------------------- <br /> ------------- <br /> -------------- <br /> -------------- <br /> oEP RTMEN OLY. Ti PAYMENT <br /> Application Accepted 8 Date Area i Employee IDS RECEIVED <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Pt:� PWSump Soil Character: APR 0 n <br /> COMMENTS 2LF26 <br /> SAN JOAQUIN COUNTY <br /> PE SC R:eoelved Che� Amount pe�� <br /> HVIRDNMEN7AL <br /> Code INFO rash I R ' �� Service uest Irrvoice 0 Permit IDaRH TH DEPARTMENT <br /> IL <br /> 42-01 <br /> 4114119 ONS CFE WASTEWATER TRTMNT SYSTEM PERMIT <br />