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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E.HAZELTDN AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 10516 E.Peltier Road CITY/Zip Acampo CA 95220 v <br /> CROSS STREET Sowles Road APN 017-260-31 PARCEL SIZE 2.0 <br /> e <br /> OWNER NAME Grlbaudo PHONE , <br /> OWNER ADDRESS 10516 E.Peltier Road CITYISTATE/ZIP Acampo,CA 95220 <br /> CONTRACTOR Terracon Consultants Inc. PHONE 209-269-8586 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY Cm/STATE/ZIP LODI CA 95240 <br /> LICENSE ❑LIC-42 ❑_IC-36 OTHER C-57 NUMBER 669004 ExPIRATION DATE 05-31-2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> IX PERC TEST IF 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION I I REPAIR/ADDITION I ENGINEER D GNED/ALTERNATIVE <br /> REPLACEMENT I i OUT-OF-SERVICE SEPTIC SYSTEM �I DESTRUCTION <br /> INSTALLATIONWILL SERVE: ❑ RESIDENCE ElCOMMERCIAL ❑ 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 O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 71 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL II FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMaER WIDTH ft DEPTH it <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 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 /> MINIMUM48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGNEDt��— TITLE STAFF SCIENTIST DATE 10-17-19 <br /> K.ea n+>1+1.o+snn <br /> ufklwl <br /> T7 •. <br /> Y <br /> C- f <br /> it <br /> 0 <br /> Application Accepted By Data AreaEmployee ID#� <br /> Final Inspection By Date 1) SPE L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck# AmountPermit/ <br /> ode INFO B as emitted Date Service Re est# Invoice# Permit 10# <br /> Z v � 10-4A <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />