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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95206-(209)1468-3420• <br /> NON-REFUNDABLE PERMIT / CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6486 Loramar Ln �j Li 7F� Lo rt,m Lt r CITY/ZIP Tracy,CA rn <br /> Banta R/d. DpCROSS STREET '25 01 <br /> c '3 1)/ XPARCEL SIZE 1 ; <br /> OWNER NAME Lid SGSOn Ierina =� <br /> PHONE <br /> OWNER ADDRESS {e-.�7 8 �/�Larri m eo, CITY/STATE/ZIP /•nC CA "I J j 0 <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATEIZIP Manteca,CA 95336 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O LAND USE APPLICATION# 1 <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION 7 ENGINEER DESIGNED/ALTERNATIVE <br /> fl REPLACEMENT fl OUT-OF-SERVICE SEPTIC SYSTEM l DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERC L ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG PBL concrete CAPACITY 1600 gal #OF COMPARTMENTS <br /> O GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL100 ft FOUNDATION 5 ft PROPERTY LINE 40+ It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IQ LEACH LINES I I LEACHING CHAMBERS #OF LINES 4 LENGTH OF LINES 100' ft <br /> DISTANCE TO NEAREST WELL 100 it FOUNDATION 15' ft PROPERTY LINE 40+ 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 R <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. w <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. H <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 C e/V <br /> SIGNED Mike Fuller TITLE Contractor DATE 4/3/2020 ED <br /> APR 0 6 2020 <br /> oRONM NOUNTY <br /> TA L <br /> S e e A t t a c h e d d o c Tf{DEpATMENT <br /> //DEPARTMENT US ONLY <br /> Application Accepted By ���s ��lcys` Date a 9 Area a Employee ID#� <br /> Final Inspection By Date 0 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil toDepthof 3 Ft: P' Sump Soil,Character: <br /> COMMENTS ar NZ. r4z walls abSQ.yedw,r tk n —InAmu"VI se}back 6f the vr„aosed <br /> sept{c w;5fern Per ca mi/ recon/. Neter► SFR, sPc"d am'* <br /> PE SC Received Che Amount Date Permit( Invoice# Permit ID# <br /> Code INFO B as Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />