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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 AV CITY/ZIP RIPON, CA <br /> CROSS STREET ALLEN ROAD � ���� API 24 � �/pV '�1 PARCEL SIZE 1-80 p <br /> C <br /> OWNER NAME GUILLERMO RAMIREZ PHONE 209-652-2037 <br /> OWNER ADDRESS 8115 E. MONTE VISTA CITY/STATE/ZIP DENAIR CA 95316 <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 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 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�y� ft <br /> E3 FILTER BED WIDTH ft LENGTH ft DEPTH ••P.I14 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 1 <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH N IO Q <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE H Z� /R6Z,, CO <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH EPA ft <br /> ft y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE /v <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 /> MINIMUM 8 REQUIRED F L (209)953-7697 <br /> SIGNED �— y (/�� L L�/� U TITLE STAFF SCIENTIST DATE <br /> 0 <br /> I.t.. Q <br /> .�' <br /> J - <br /> • tl!��, .. r� ALLEN ROAD <br /> z <br /> DEPARTMENT SE 42 N L Y ' / <br /> Application Accepted By Date Area. Employee ID V <br /> Final Inspection By ✓1.. Date 2 To _ SPEC AL PERMIT-Approved by <br /> Character of Soil to Deth f 3 Ft: Pi Sump Soil Character: <br /> COMMENTS 6.�q *%xy,& <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> 4 Code <br /> �7 INFO B Cash Remitted Service Request# <br /> �Z l� !J ,AK �zz z, ,1 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />