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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 Jos ADDRESS 25670 Elm CITYIZip Farmington,CA y r � CROSS STREET w INC) 1` APN l Z1S �_-Z PPARRCCELLSIZE OWNER NAME^"X� 1�'Yk I fl T CISnn ELI � PHONE 1(S f)t9 � 5-3 OWNER ADDRESS P0 60A v IGI CITY/STATE/ZIP CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATE/ZIP Manteca,CA 95336 LICENSE ❑GC-42 �]-C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y J PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: EW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGTED/A TERNATIVE REPLACEMENT 1200 +[!,VI k ❑ OUT-OFSERVICE SEPTIC SYSTEM k DESTRUCTION INSTALLATION WILL SERVE: IWIRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:2 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: WELL 1`1 Of- ft FOUNDATION it PROPERTY LINE In/ ft ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINES 55 it DISTANCE TO NEAREST WELL Public ft FOUNDATION 10 ft PROPERTY LINE 5 ft ❑ FILTERBED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE fl 0 MOUNDED WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH it LENGTH it DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH It DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE fl 0 SEEPAGE PITS NUMBER 2 WIDTH 42" ft DEPTH 25' ft DISTANCE TO NEAREST WELL ft FOUNDATION 10 it PROPERTY LINE 5 It 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 wa HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED Mike Fuller TITLE Contractor DATE 5/16/2020 Tit V N LOCI FNrq��y RTIyeN) DEPARTMENT U SF ONLY Application Accepted By Date Area / —// Employee ID# Sit Final Inspection By Data * SPECIAL PERMIT-Approved by Character of Soil to Dep of 3 Ft: PIU ump Soil Character: COMMENTS ¢crit ,Ie d ` °YS�Pn'1- %'f'( PE SC Received hec Amount ate PermiU Invoice# Permit ID# Code INFO By Remitted 11D i Service Re uest# a o X 15 30o S N 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118