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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 />NON-KEFUNDABLE PERMIT <br />JOB ADDRESS 6631 South Jack Tone Road <br />CROSS STREET Mariposa Rd. <br />OWNER NAME Dennis Faist <br />OWNER ADDRESS 6595 South Jack Tone Road <br />CONTRACTOR T&S West <br />CONTRACTOR ADDRESS PO BOX 1592 <br />LICENSE I C-42 C36 OTHER A & B <br />WATER TABLE DEPTH: <br />_CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSL <br />Cm/ZIP Stockton, 95215 <br />APN 181-080-170 PARCEL SIZE 1.19 <br />PHONE (209)639-1581 <br />CITY/STATE/ZIP Stockton, CA. 95215 <br />PHONE (209)652-7811 <br />Cm/STATEfZIP Linden, CA. 95236 <br />NUMBER 939001 EXPIRATION DATE 10/31/2021 <br />It GEOGRAPHICAL INFORMATION' (�nnrAinafae Y / Z I, Il � tO v 4 / .94'911 <br />PERC TEST # <br />I I BUILDING PERMIT # <br />LEACHING CHAMBERS # OF LINES I LENGTH OF LINES.•? <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />WELL /OrJ R FOUNDATION R PROPERTY LINE <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION SrPr 1 Z +'! N A <br />INSTALLATION WILL SERVE: REstaENCE <br />-. COMMERCIAL <br />OTNEA <br />NUMBER OF LNwo UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />/ ^ <br />TYPEIMFG ! IV CJX,6j C <br />0 <br />CAPACITY '7Q Is gal # OF COMPARTMENTS_L� <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />MOUNDED <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />R PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�^ f DEPARTMENT US ONLY <br />Application Accepted y! G �z Date Z OZd Area r �C Employee 10# DA <br />Final Inspection By Date ZOW SPECIAL PERMIT -Approved by <br />Character of Soil tgeoth o13 Ft: - G PRISump SqV Character: <br />CO ENTS _I'l.+r . CDI�I�/OTC �4rtYL D S <br />r -4 -el -C — ,recel' <br />lCoda INFO ey 1 I gash- I Remitted Date I Service Request # I Invoice # I Permit ID# <br />Iy2ZI 10as- IIImo- I1I5-a ILI.22.W1 St2(ll���..nln I <br />42141 <br />4/14/18 ll( <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />T <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES I LENGTH OF LINES.•? <br />ft <br />DISTANCE TO NEAREST <br />WELL /OrJ R FOUNDATION R PROPERTY LINE <br />❑ <br />FILTER BED <br />WIDTH <br />R LENGTH R DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE <br />ft <br />v <br />❑ <br />MOUNDED <br />WIDTH <br />I R LENGTH R DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE <br />R <br />Cl <br />SUMPS <br />WIDTH <br />R LENGTH R DEPTH <br />(( <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE <br />It <br />❑ <br />DISPOSALPONDS WIDTH <br />R LENGTH R DEPTH <br />It <br />(� <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE <br />It <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH R DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE <br />R <br />I HEREBY <br />CERTIFY THAT <br />I HAVE PREPARED THIS APPLICATION <br />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 />^` <br />NI <br />48 HOUR ADVANQEN077CE <br />REQUIRED FOR IN C 0953-7f971�' <br />SIGNED <br />/�— <br />TITLE ?l-'ZLL :Z4 ,4A-1.Qi DATE;447A <br />� r <br />ZO <br />"1 <br />�^ f DEPARTMENT US ONLY <br />Application Accepted y! G �z Date Z OZd Area r �C Employee 10# DA <br />Final Inspection By Date ZOW SPECIAL PERMIT -Approved by <br />Character of Soil tgeoth o13 Ft: - G PRISump SqV Character: <br />CO ENTS _I'l.+r . CDI�I�/OTC �4rtYL D S <br />r -4 -el -C — ,recel' <br />lCoda INFO ey 1 I gash- I Remitted Date I Service Request # I Invoice # I Permit ID# <br />Iy2ZI 10as- IIImo- I1I5-a ILI.22.W1 St2(ll���..nln I <br />42141 <br />4/14/18 ll( <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />T <br />