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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 5484 West ST.RT.12 Hwy CITY/ZIP Lodi 95241 <br /> CROSS STREET N.Flag City Blvd. APN 055 '(,,L/d� PARCEL SIZE V r <br /> OWNER NAME Alegre Trucking PHONE <br /> OWNER ADDRESS 5464 W.ST,RT.12 CITY/STATE/ZIP LODI 95241 <br /> CONTRACTOR Haley Contracting PHONE 209-463-2517 <br /> CONTRACTOR ADDRESS 4228 Newton Road CITY/STATE/ZIP Stockton,CA 95205 <br /> LICENSE C-42 C-36 OTHER A NUMBER 580907 EXPIRATION DATE 11/30/2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# ` i LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE X COMMERCIAL OTHER ' ri\ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:1 IU v tst J <br /> SEPTIC TANK TYPE/MFG �C CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ' ^O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES k LEACHING CHAMBERS I— #OF LINES C IJ LENGTH OF LINES + ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION —�-�� dd-- ft PROPERTY LINE 4 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> ouRADVANG6NOTICE REQUIRED FOR IN TI N -P EASE CALL 209J 953-7697 <br /> SIGNE I TITLE'OQ 41 igDATE10 <br /> re <br /> �cF,V�r <br /> ti l �1 FO <br /> N��c j0,0 <br /> F,ogRFT qU, ry <br /> MFNT <br /> DEPARTMENT USE ONLY G {�J� <br /> Application Accepted 3y ��� Date tJ✓J ���� Area Employee ID# JA <br /> Final Inspection By Date `Z SPECIAL PERM/ ;Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: ryy'F\� <br /> COMMENTS /v�vJ CorvIW1BICiGI Sys C'YN (Qyy t<lr"Il Is publl( pet /1?L. /lIG;/rIY✓ILM So) <br /> coyer over chcjm6ets sk l)'he aij inches' of drench shall be +-QO2 <br /> PE Sc Received Amount Date Permit/ Invoice# Permit ID# �J <br /> Code INFO IS Cash Remitted Service Request# <br /> SO <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />