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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 109 953-7697 FOR INSPEC77ONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 10516 E.Peltier Road Clrr/ZrP Acampo CA 95220 ti <br /> r� <br /> CROSS STREET SOWI8s Road APN 017.260-30 PARCEL SIZE 35.61 <br /> b <br /> OWNER NAME Gnbaudo PHONEa <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 CITYISTATE/ZIP LODI CA 95240 <br /> LICENSE ❑i iC-42 ❑ iC-36 OTHER C-57 NUMBER 669004 E%PIRATION DATE 05-31.2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST A BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ;J NEW INSTALLATION U REPAIR/ADDITION ''.1 ENGINEER DESIGNED/ALTERNATIVE <br /> :I REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 1-1 LEACHING CHAMBERS #OF LINES LENGTH OF LINER R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE To NEAREST WELLft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE it <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME it <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT 1 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 /> 8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLF-ASE CALL(209)953-7697 <br /> SIGNED t7u� -z—^- TITLE STAFF SCIENTIST DATE 10-17-19 <br /> lRveccna..oruau <br /> NVN/CHH <br /> Iu ei J y,- J <br /> �II <br /> Ilf <br /> Application Accepted By Date 6 AreaEmployee ID#, , <br /> Final Inspection By Dete ❑ SP. AL IT-Approved by <br /> Character of Soil to Depth of 3 Fl: Plt/Sump Soil Charecler: <br /> COMMENTS <br /> PE SC Received Chadd! Amount Date Permit/ Invoke R Permit ID/ <br /> Code INFO By Cash Remitted ,SSeerviceRs ue <br /> LJ?/ Iliil1�� ' sl2dv Sesst# <br /> 42ol ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />