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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 GALL ZU9 903-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 17159 Los Padres Drive CITY/ZP Tracy 95304 <br />CROSS STREET Von Sosten Rd./Los Ranchos Dr. APN 20938020 PARCELSIZE 2.09 acres <br />OWNER NAME Harold Pace Stokes PHONE 209-815-2516 <br />OWNER ADDRESS 17159 Los Padres Drive CITY/STATE/LP Tracy, CA 95304 <br />CONTRACTOR <br />PHONE <br />CONTRACTOR ADDRESS CITYISTATEIZIP <br />LICENSE II C-42 II C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X 37.749356 Y -121.521636 <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED /ALTERNATNE <br />X REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION �'J ( fA-) a^ <br />INSTALLATION WILL SERVE: IX RESIDENCE I I COMMERCIAL I_I OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: <br />® SEPTIC TANK TYPE/MFG Concrete/ P&L Concrete ProductTAPACITY 1900 gal # OF COMPARTMENTS 2 <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL N ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WELL <br />it FOUNDATION ft PROPERTY LINE <br />ft <br />❑ FILTERBED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY UNE <br />ft <br />❑ MOUNDED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SUMPS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY UNE <br />ft <br />❑ DISPOSAL PONDS WIDTH It LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY UNE <br />ft <br />❑ SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION It PROPERTY LINE <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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED <br />TITLE L2L,3,-) 'T— DATE QJ -al j <br />-Ac °f,Nr <br />EiVZ6 <br />�QUlly Cp <br />,gftfi ul— TY <br />DgF`ARTUENTj0EQNjLY �� n <br />Application Accepted By Data c� Area S �� Employee ID# <br />Final Inspection By A Date ViW ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS,?>5 L l � i,f C, i�eJ ►¢�� <br />PE SC Received Chec Amount Date Permit/ Invoice # Permit ID# <br />Code INFO s Remitted Service R uest# <br />Alto 5 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4124112 <br />