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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 1� >I r <br /> SAN JOAQUIN COUNTY ENYIRONMCNTAL HEALTH DEPARTMFNT 186B E.HAZE LTON 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 32851 S CHRISMAN ROAD CITy2ip TRACY CA <br /> P <br /> CROSS STREET DURHAM FERRY ROAD OR VERNALIS/HWY 132 APN 253-190-10 PARCEL SIZE 1.10 e <br /> / C <br /> OWNER NAME ANTHONY J AND BETRICIA'PICKENS PHONE 209-814-1431 JOHN PICKENS <br /> OWNER ADDRESS 32851 S CHRISNOIAN ROAD CITYISTATEILP TRACY CA 95304 <br /> CONTRACTOR TERRACON CONSULTANTS(NEIL O.ANDERSON 8 ASSOCIATES) PHONE 209-307-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY7STATE/ZIP LODI.CA95240 <br /> LICENSE C-42 C-38 OTHER C,�i7 NUMBER 669O04 EXPIRATION DATE <br /> r A <br /> WATER TABLE DEPTH: I Vi I ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> x PERC TEST # ' BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAR IADDITION ENGINEER DESIGNED?ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE _ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFO CAPACITY gal #OFCCfAPARTMENTS _ <br /> DISTANCE TO NEAREST: WEL. ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST NELL ft FOUNDATION _ R PROPERTYLINE ft <br /> ❑ FILTER BED WIDTH R LENGTH it DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH_ ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WEll ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH fl <br /> DISTANCE To NEAREST WELLIt FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WtorH ft LENGTH _it DEPTH R <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY UNE. <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I NAVE 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!2091953-7697 <br /> SIGNED TITLE STAFFSCIENTIST DATE 8-2-18 <br /> mercer Tar I C <br /> Tac <br /> '4 <br /> inti±, <br /> DFPARTAIENT USE ONLY <br /> Application Accepted B v �1: Date Y Area I h Employee IDB AY1lY1P <br /> Final Inspection By ---- Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth offWV44. Plt1Sump Soil Character: <br /> COMMENTS _ <br /> PE SC Received Amount Date Permit! InvduM PermitlDM <br /> Code INFO By Cash Remitted Servin R est M <br /> ,4SL2—mcf-i'mi <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> V14110 <br />