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r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQLI IN COUNTY ENYIR ORM ENTAL HEALTH DEPARTN ENT 1868 E.HAY£LTON AVENUE-STOCKTON CA 9 52 05- 209)468-3420 <br /> }VON-REFUNDABLE PERMIT CALL 2a9 953-7597 FOR INSPE'CTIO IVS ExPIRES 7 YEAR FROM DATE ISSUED <br /> JOS ADDRESS 5484 W.HIGHWAY 12 CITYIZIP LODI,CA 95242 m <br /> H <br /> M <br /> CROSS STREET FLAG CITY BLVD APN 065.160-23 PARCEL SEZE 10'78 c <br /> b <br /> TONY ALEGRE 209-200-2103 <br /> OWNER NAME PHONE <br /> OWNER ADDRESS 4898 W.HIGHWAY 12 C nYIS7A7EIZJP LODI.CA 95247 Y <br /> CONTRACTOR TERRACONCONSULTANTS ING PHONE 209-367.3701 <br /> CONTRACTOR ADDRESS 9021NDUSMAL WAY CITYISTATElLIP LODI,CA9524O <br /> LICENSE d C•42 01:C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5(31119 <br /> WATER TABLE DEPTH: 14 R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# _ LAND USE APPLICATION# Q <br /> TYPE OF WORK _ NEW INSTALLATION REPAIRIADDITION ENGINEER DE IGNED(ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: E RESIDENCE Li COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: NUM 9ER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE1MFG CAPACITY gal #OF COMPARTMENTS <br /> 3 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DIS7ANCETONEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> C] LIFT STATION SIZE TYPE OF PUMP ❑ PKG TXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE _ R <br /> Ll FILTER BED WIDTH ft LENGTH It DEPTH R <br /> DISTANCE To N EAREST WELL N FOUNDATION ft PROPERTY LINE R <br /> 0 MOUNDED WIDTH ft LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> O SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNCA71ON ft PROPERTY LINE I <br /> U DISPOSAL PONDS WIDTH ft LENGTH R DEPTH k <br /> DISTANCE 7O NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> O SEEPAGE PITS NUMBER WIDTH fl DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TH18 APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM$8 HOUR ADVANCE NOTICE QFQUIREQ FOR INSPECTIONS Y PLEASE CALL f2O9)953--= <br /> SIGNED .f L.c'�i.fZ-L%i� Y'y 1 L. TITLE STAFF SCIENTISTDATE JANUARY 10,2019 <br /> W HIC.".KAY I- <br /> f' <br /> r I�I <br /> r r <br /> Application Accepted B Date Area Employee 100 <br /> Final inspection By Date f .I $PEGIAL PERMR-Approved by <br /> Character of So ll to Depth of 3 Ft- PitlSump,SSoil Ch <br /> COMMENTS r <br /> PE Sc Received ack# Amount Date Permit/ Invoice# Permit IDN <br /> Code INFO ash Remitted Service—Request 0 <br /> Z 2-aasaU� r <br /> 42.01 ONSITE WASTEWATER TRTFANT SYSTEM PERMIT <br /> 4!14118 <br />