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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 />JOB ADDRESS _ 18650 Rodeo Dr <br />CROSS STREET Atkins Road <br />953-1697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />CITY/ZIP Clements, CA 95227 <br />APN 019-320-12 PARCEL SIZE 9.20 acres <br />OWNER NAME_ Richard Pruden <br />OWNERADDRESf4849 Mosher Drive <br />CONTRACTOR_Terracon Consultants, Inc. <br />CONTRACTOR ADDRESS 902 Industrial Way <br />LICENSE C-42 a -,C-36 OTHER C57 <br />PHONE 209-810-5401 <br />CITY/STATE/ZIP Stockton, CA 95212 <br />_ PHONE 209-367-3701 <br />CITY/STATE/ZIP Lodi, CA 95240 <br />NUMBER 669004 EXPIRATION DATE 5/31/2019 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Ys-: PERC TEST #_ 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br />Received <br />By <br /># OF LINES <br />LENGTH OF LINES <br />Permit/ <br />Service Re uest # <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />�L-h <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED <br />VR IIYJrC\+I IVIYJ - rLCM JC l -u-L- I&VU1 voo-I UJI <br />TITLE_ Staff Scientist DATE _ 11/3/2017 <br />DEPARTMENT USE ONLY <br />Application Accepted By -L-- Date I I / % Area Employee ID# WC/11— <br />Final <br />C/11%Final Inspection By Date 2 t SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 4QS4- ee �,I. -"b 0 P1-1 4-J --/- 4IQS -0 9 <br />�lcdl, h `a9�Ctz�-; d'�f3 36bag = z7.7 <br />If <br />M <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />PE <br />Code <br />Sc <br />INFO <br />Received <br />By <br />Check#/ Amount <br />Cash Remitted <br />Date <br />Permit/ <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />f7� I� <br />ii <br />�L-h <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 <br />