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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 GALLLU9 953-76'97 FOR INSPECTIONS tXPIRES 1 YEAR FROM UATE ISSUEI <br />JOB ADDRESS 32851 S CHRISMAN ROAD CIN/ZIP TRACY CA <br />CROSS STREET DURHAM FERRY ROAD OR VERNALIS/HWY 132 APN 253-190-1 <br />OWNER NAME ANTHONY J AND BETRICIA'PICKENS <br />OWNER ADDRESS 32851 S CHRISMAN ROAD C <br />CONTRACTOR TERRACON CONSULTANTS (NEIL O. ANDERSON & ASSOCIATES) <br />CONTRACTOR ADDRESS 902 INDUSTRIAL WAY <br />0 PARCEL SIZE 1.10 <br />PHONE 209-814-1431 JOHN PICKENS <br />ITY/STATE/ZIP TRACY CA 95304 <br />PHONE 209-367-3701 <br />CITY/STATE/ZIP LODI, CA 95240 <br />LICENSE -* C-42 _ C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br />WATER TABLE DEPTH: ' �/ .� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />>< PERC TEST # 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 />TYPE/MFG <br />Received <br />B <br />CAPACITY <br />gal # OF COMPARTMENTS <br />Permit/ <br />Service Request # <br />❑ GREASE TRAP <br />TYPE/MFG <br />4),X 1 <br />CAPACITY <br />gal # OF COMPARTMENTS <br />t22MES <br />2 <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />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 <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft 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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM <br />48 HOUR ADVANCE <br />NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />Diaitally-nedhyWoods,TamaraK <br />TITLE STAFF SCIENTIST <br />DATE 8-2-18 <br />Application Accepted B <br />Final Inspection By_ <br />Character of Soil to Der <br />COMMENTS <br />I IVI V- <br />Date Area J / V/ Employee ID# <br />Date El SPECIAL PERMIT - Approved by <br />Pit/ Sump Soil Character: <br />PE <br />Code <br />SC <br />Received <br />B <br />Amount Date <br />Remitted <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />4),X 1 <br />IW4�L <br />t22MES <br />2 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />F. - <br />t= C <br />0 <br />