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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS 16475 S Tide Road CITY/ZIP Ripon,95366 v, -i CROSS STREET E French Camp Road APN 203-10G-17 PARCEL SIZE 0.94 > 0 y� 0 OWNER NAME Jennifer 8 Chad De Jong / L PHONE 209-968-6384 m OWNER ADDRESS PO Box 131 / t'IG D� !/( ��-s CITY/STATE/ZIP Ripon,CA 95366 y CONTRACTOR PETRALOGIX ENGINEERING,INC. T PHONE 209-770-0731 CONTRACTOR ADDRESS 26675 Bruella Road CITYISTATE/ZIP Galt,CA 95632 LICENSE -! C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: -55m60fe wib g—ndsurtaw It GEOGRAPHICAL INFORMATION: Coordinates X Y K PERC TEST #' I I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal It OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) qY ECE e�r L3 LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft VE® DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE P O Q ❑ FILTER BED WIDTH ft LENGTH ft DEPTH �O�y DISTANCE TO NEAREST WELL It FOUNDATION ft fL PROPERTY LINE 84A Ll MOUNDED WIDTH ft LENGTH ft DEPTH I�'Jy QVIN CO DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE HEA, I �N1�EN1.UNTy ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft �FpA) Tr AL DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. REQUIRED SIGNED � Isc46, V O/V\ TITLE -zLC3 , DATE-4I LAG -.�� :e r•�' Q R 4.. 4 • - - — Yr v y 7n �+�s,�C; �+' s r 54 .p PAR TM ENT LIS E ALLY Application Accepted By Date Area Employee ID# Final Inspection By Date I SP AL PERMIT-Approved by Character of Soil to D th of 3 Ft: PiUS mp Soil Ch7a It : COMMENTS��i►�Ge�/ _ �� LYol //!tC PE Sc Received Check#/ Amount PenniU Date Invoice# Permit ID# Code INFO B ash emitted Service Request# 42-01 // 9/ Q� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118