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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 26850 N. LOWER SACRAMENTO ROAD CITY/ZIP ACAMPO, CA U <br /> m <br /> CROSS STREET LIBERTY ROAD APN 005-030-07 PARCEL SIZE 70.0 0 <br /> O <br /> OWNER NAME VENTANA DEVELOPMENT CO. INC. C/O NORMAN HULBERG PHONE 408-279-1520 <br /> OWNER ADDRESS 55 MARKET STREET, SUITE 1210 CITY/STATE/ZIP SAN JOSE, CA 95113 <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 C-36 OTHER C-57 NUMBER 710079 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # 10(25 ft) 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 Y ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> J <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH UN�r 9 9n0Aft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN `"r`f ft <br /> JO <br /> O <br /> El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH aa7� E AQUIN C01jN .ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LkWrAL7-H DEP ENTAL ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH MENT 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 /> M IM 8 HOUR ADVANCE NQTICE REQUIRED FR INSPECTIONS - PLEASE CALL 209)953-7697 <br /> SIGNED �. Ct l 7 L�Ztz L L-LL� �� TITLE STAFF SCIENTIST DATE 06/10/2019 <br /> LIBERTY ROAD <br /> Cr, <br /> M <br /> CA <br /> n � <br /> z <br /> -4 {: c:' <br /> 0 c•; <br /> D .PARTME TUSE,6NLY <br /> Application Accepted By, Date Area Employee ID#� <br /> Final Inspection By \t A -Z4 AA ((L�IL Date SPE AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By --L—ash RemittedII Service Request# <br /> 72- W �Z <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />