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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 ISSUE[ <br />JOB ADDRESS 21379 N. Mann Road CITv/ZIP Acampo / 95220 <br />CROSSSTREET Acampo Road APN 017-280-09 PARCELSIZE 10.05 AC. <br />OWNER NAME Brent Workman PHONE (209) 810-4521 <br />OWNER ADDRESS 21379 N. Mann Road CITY/STATE21P Acampo / CA / 95220 <br />CONTRACTOR Dillon & Murphy PHONE (209) 334-6613 <br />CONTRACTOR ADDRESS P.O. Box 2180 CITY/STATE/ZIP Lodi / CA / 95241 <br />LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: <br />It GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />X PERC TEST # <br />2 BUILDING PERMIT # <br />LAND USE APPLICATION # Pa -1700251 <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />ft DEPTH ft <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: C RESIDENCE <br />1 COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />It PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY UNE ft <br />❑ MOUNDED <br />WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION ft PROPERTY LINE It <br />❑ DISPOSAL PONDS <br />WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY UNE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION ft PROPERTY UNE 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 />MINIMUM 24 <br />WbIVADVANCE <br />RCE -R <br />UIRED FOR INSPECTIONS - PLEASE CALL (209),953-769 <br />SIGNED <br />TITLE Party Chief DATE 2-8-18 <br />PA <br />j EB 15 <br />S"'N ► IOIIRONM <br />HEALTH DEPA <br />Application Accepted By <br />Final Inspection By AS f- C <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS LOO- 1 <br />Lo 4-- Z Pef G - <br />Date <br />r Pit/Sump Soil <br />•10><12 I•Z 31 <br />1-2 -4,011•i z 2S-� <br />Area Employee ID# <br />1 SPEC ALP MIT - Approved by <br />- 7- _ zs <br />42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24112 <br />