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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205.(209) 466-3420 <br />Cvoiocc 1 YFOR FROM DATE ISSUED <br />NON-REFUNDABLE PERMIT CALL (LUy, <br />JOB ADDRESS 16461 East Comstock Road <br />CROSS STREET Tully Road <br />Lawrence Sambado <br />OWNER NAME <br />Sod <br />OWNER ADDRESS <br />CONTRACTOR Haley Contracting <br />CONTRACTOR ADDRESS 4228 Newton Road <br />LICENSE C-42 X C-36 OTHER A <br />yaJ-Iuw rvrcu��r�......... ---- -- <br />CITY►ZIP Linden 95236 <br />APN 091-OQu �7 PARCEL SIZE Cres <br />209 969-8077 <br />PHONE <br />N Tull <br />CITY/$TATE/ZIP Linden, CA 95236 <br />ry <br />PHONE 209-463-2517 <br />CITY/STATE/ZIP Stockton CA 95205 <br />NUMBER 580907 EXPIRATION <br />11-30-2017 <br />TABLE DEPTH: V1`� ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />Permit/ Invoice # Permit ID# <br />Service Request # <br />WATER <br />BUILDING PERMIT <br /># RP 1601402 LAND USE APPLICATION # <br />s ��,� <br />PERC TEST # <br />ENGINEER DESIGNED /ALTERNATIVE <br />TYPE OF WORK: NEW INSTALLATION <br />X REPAIR/ADDITION <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />REPLACEMENT <br />INSTALLATION WILL SERVE: RESIDENCE <br />X COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />fl <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />® LEACH LINES X LEACHING CHAMBERS <br /># OF LINES 3 <br />LENGTH OF LINES 90 <br />ft <br />DISTANCE TO NEAREST WELL 7001 <br />ft FOUNDATION 550' <br />ft PROPERTY LINE 150' <br />ft <br />❑ FILTER BED WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />SEEPAGE PITS NUMBER 3 WIDTH <br />421 <br />ft DEPTH 25 feet <br />ft <br />DISTANCE TO NEAREST WELL 800 <br />ft FOUNDATION 500 <br />ft PROPERTY LINE 1001 <br />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 />MIA16U# 24—VO ADV CE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED c C <br />TITLE President <br />DATE June 14, 2016 <br />,N1WENT <br />Flvieo <br />4 2016 <br />� <br />LAv ALNT <br />DEPARTMENT USEjONLY <br />Application Accepted By i,�/ fit, Date Area Employee ID#� <br />Final Inspection By � Date 7 SPECIAL PERMIT,,- Approve by <br />Character of Soil to Depth of 3 Ft: 1I Pit/Sump Soq Character: S,,2 y <br />COMMENTS f, 12 VJ �� — NeW �qaV1Lq f EA14 �- :F -Cts" Ab <br />y IIMAA Pio ►MA (5e Dt: 60-0 07 <br />J <br />PE SC ReceivedChec Amount <br />Code INFO B Remitted <br />Date <br />Permit/ Invoice # Permit ID# <br />Service Request # <br />H24a _ .. <br />p�►�11,o <br />s ��,� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 <br />