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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 />GALL (ZUB)9bJ-f0Yf FOR INSPECTIONS tXPIRES T TEAR FROM UATE ISSUE <br />JOB ADDRESS 120 West Acamno <br />Rd. clTyaw, Acamno 95241 <br />CROSS STREET N Rai/ Rd <br />APN[)1'1-120-R.r, PARCEL SIZE 13 12 Acres <br />OWNER NAME Rennett <br />PHONE 209-810-5362 <br />OWNERADDRESS 120 West Acamno <br />Rd. CITYISTATEIZIP Acamno CA 95241 <br />CONTRACTOR HaIPVC ntrarting <br />PHONE 209-463-2517 <br />CONTRACTOR ADDRESS 4228 Newton <br />Rd_ CrrYISTATEIZIP Stnrktnn ('A 959n5 <br />LICENSE C-42 X C-36 OTHER C- I R A R NUMBER 580907 EXPIRATION DATE 11-30-2018 <br />WATER TABLE DEPTH:10 — Z) It GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />_ <br />PERC TEST # BUILDING PERMIT # AND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEME T OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 1 <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 7 <br />NUMBER OF EMPLOYEES: <br />C� <br />SEPTIC TANK TYPE/MFG Jensen CAPACITY 1500 <br />gal #OF COMPARTMENTS 2 <br />❑ <br />GREASETRAP TYPE/MFG CAPACITY <br />gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL It FOUNDATION <br />It PROPERTY LINE ft <br />LIFT STATION SIZE 5 Hprrg - TYPE OF PUMP Myprq ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Q( <br />LEACH LINES X LEACHING CHAMBERS #OF LINES �_ <br />LENGTH OF UNES 90 ft <br />DISTANCE TO NEAREST WELL 150 It FOUNDATION <br />ft PROPERTY LINE ,in ft <br />❑ <br />FILTER BED WIDTH ft LENGTH ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION <br />ft PROPERTY LINE _ ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />SESPAGE BER <br />It <br />DISTANCE TO NFewper i ❑I fl•-7TJONOA,IAH <br />w 'OPERTY L1I4E 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 />STALE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED / TITLE / DATE <br />3'90' Url� <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 <br />Code I INFO <br />42.01 <br />4124112 <br />loo' <br />FFira►1ti•-�' fro (lc., <br />CD PARTMEN SE NLY <br />Date Area Employee ID# �%� <br />Date i& "I" SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />y4fA <br />CFA T <br />Nps 3 <br />EgC�Ro �iH co 41, <br />T <br />(4, P <br />l <br />hj -lam ke <br />Permit/ <br />ervi``ce Request # <br />Invoice # Permit ID# <br />�f) <br />0 <br />9� <br />I <br />e� <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />