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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 10516 E. Peltier Road CITY/ZIP Acampo CA 95220 <br /> CROSS STREET Sowles Road ApN 017-260-31 PARCEL SIZE 2.0 p <br /> v <br /> a <br /> OWNER NAME Grlbaudo PHONE rmi, <br /> r <br /> OWNER ADDRESS 10516 E. Peltier Road CITY/STATE/ZIP Acampo, CA 95220 <br /> CONTRACTOR Terracon Consultants Inc. PHONE 209-269-8586 <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 05-31-2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DE'SIGNED/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 /> MINIMUAU8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209) 7 <br /> SIGNED l��t"ZE C X71< � TITLE STAFF SCIENTIST DATE 10-17-19 <br /> I <br /> i I <br /> l <br /> .x <br /> Aq q <br /> F <br /> I� <br /> J <br /> EPARTMENTUS O LY <br /> Application Accepted B ZAADate Area Employee ID# <br /> Final Inspection By Date / ❑ SPE L PERMIT-Approved by <br /> Character of Soil to Depth of 3 F(• Pit/Su Soil Character: <br /> COMMENTS ivt�(U T� Ss g f + -t ' I + i <br /> c ✓l of s 111 'FA,v✓1l�t'I L ;fie'd S <br /> V11 f'c - 44 i 0'.e(� r "'t's a, l Ou l<�r SC l,t <br /> PE Sc Received Check# Amdunt Permit/ <br /> Date Invoice# Permit ID# <br /> ode INFO By as emitted Service Re uest# / <br /> zZ ZIt <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />