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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 ISSUED <br /> JOB ADDRESS 12110 E.Jahant Road CITY/ZIP Acampo, CA 95220 <br /> :j <br /> ra <br /> CROSS STREET Elliott Road ApN 007-280-46 PARCEL SIZE 4.97 p <br /> 0 <br /> OWNER NAME Bert AZeyedo PHONE 209-993-4817 <br /> OWNER ADDRESS 12110 E.Jahant Road CITY/STATE/ZIP Acampo, CA 95220 <br /> CONTRACTOR TERRACON CONSULTANTS INC. PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI CA 95240 <br /> LICENSE C-42 I 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 # 2 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 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 #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> MINIMU17VL48 HOUR ADVAN ENOTICE <br /> TI E REQUIRED FOR INSPECTIONS -PLEASE CALL 209)953-7697 <br /> SIGNED / �- �''` \ TITLE ENVIRONMENTAL CONSULTANT DATE 04/10/19 <br /> E Ni „ <br /> r <br /> ut c Tr <br /> r"� RAE=1am <br /> NT <br /> 0 PARTMENTIJSEIONI.Y <br /> Application Accepted Rv Date Area Employee ID# <br /> Final Inspection By Date — SPECI L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Su p Soil Character: <br /> COMMENTS�P/� /B� % 4S Sy•"•� ,awl^-• fir �Z �tc./ �n=k�. <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BCash mitte Servic a uest# <br /> �i v 2 I 7 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />