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f <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)488-3-420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 4764 E Woodward Ave. CTFy/ZIP Manteca.CA 85337 ' <br /> I � <br /> CROSS STREET Urdon Rd. APN :i `%L" / PARCEL Size <br /> OWNER NAME Kiper Development PHONE 925.648-8888 <br /> OWNER ADDRESS 3200 Denville Blvd.Ste.#200 CITYISTATEIZIP AlaInO,CA 94507 <br /> CONTRACTOR R d D Equipment,Inc. PHONE 510-782-3774 <br /> CONTRACTOR ADDRESS 2215 Dunn Rd. CTrYISTAT,rZW Hayward,CA 94546 <br /> LICENSE ❑OC-42 ❑LIC-36 OTHER NUMBER E%PIRAnoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # BUILDING PERMIT X LAND USE APPLICATION# <br /> TYPE Of WORK: 0 NEW INSTALLATION 1.1 REPAIRIADDfTIOM _ ENGi EER DESIGNED/ALTERNATivE <br /> _ REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM - DE3TRuc'noN <br /> INSTALLATION WILLSERVE: U RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG Uwa: NUMBER OF BEDROOMS: r NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG W O D CAPACITY O v Bal #OF COMPARTMENTS� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel #OF COMPARTMENTS <br /> DISTANCE TD NEAREST: WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PLIMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES C LEACHINGCHAMBERS #OFLINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION H PROPERTY UNE ft <br /> ❑ SUMPS WIDTH If LENGTH ft DEPTH ft <br /> DIaTANCE TO NFAR53T WELL it FOUNDATION_ 1I PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH n DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY UNE II <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY UNE _ ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DOFF IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDWANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-719 <br /> - <br /> SIGNED TITLE President DATE 3-18-21 <br /> qc MSN r <br /> i u 102, <br /> IF I IJ,,1�1 PgRT°u/vry <br /> MENr <br /> TMENT <br /> N L <br /> Application Accepted By Date 7/ Area Employee ID#' a�.�K� <br /> Final Inspectlon By te \ ❑ SPEC&PERMIT-Approved by <br /> Character of Soil to Depth 01`3 Ft Plt%ump Soil Character. <br /> COMMENTS O <br /> PE SC Received ChackV Amount Permit/ <br /> Code INFO Cash Remitted ?ate Service Request III <br /> Invoice# Permit IIA/ <br /> L J <br /> I <br /> 42 01 � -; � / ONSRE WASTEWATER TRTMNT SYSTEM PERMIT <br />