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� e 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 1 YEAR FROM DATE ISSUED JOB ADDRESS 6595 s.Jacktone Rd. CITY/ZIP Stockton,CA v Maiposa Rd. dCROSS STREET 1 9' 9016 m d OWNER NAME Dennis Faist PHONE 209-639-1581 N OWNER ADDRESS CITYISTATE/ZIP CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATE/ZIP Manteca,CA 95336 LICENSE ❑❑C-42 ❑❑C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION 7 ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 1200 rl OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG P&L Concrete CAPACITY 1200 gal #OF COMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL100 ft FOUNDATION 75 ft PROPERTY LINE 25 ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES i i LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES 55, ft DISTANCE TO NEAREST WELL 100 ft FOUNDATION 80 ft PROPERTY LINE 25 ft ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER 3 WIDTH 36" ft DEPTH 25' ft DISTANCE TO NEAREST WELL 150 ft FOUNDATION 120 ft PROPERTY LINE 25 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED Mike Fuller TITLE Contractor DATE I 1A F YMF Qcov P4 7.4L Nr j� l DEPARTMENT SE NLY a(� /I Application Accepted By /v!/ Date ZJ u Area I /—/ Employee ID# DA Final Inspection By Date 0 ElSPECIAL PERMIT-Approved by Character of Soil to Dept of 3 Ft: PI Sump Soil Character: COMMENTS - •s+Iir vii' b exi }0 sfe P 't n ch lIneuc rn&V &115koyp be c tter f- lr CC 0>7+144Of, Rf,614M h a n d /rh sMyvi PE41NFF0 Received Check# Amount Date Permit/ Invoice# Permit ID# Code B Remitted Se 'c Re uest# ;1 Q 430 42-01ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4 14;18