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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 JOB ADDRESS 23555 N.GRAHAM ROAD CITYIZIP ACAMPO CROSS STREET JAHANT AIN 007-270-49 PARCEL SIZE 4.88 OWNER NAME I I I I 0101 �OS�T a C,, 3 C M.I V PHONE OWNERADDRESS d3ajlf N 61/13" RCl CITY/STATE/ZIP A,(..mwCA CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-269-8586 CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/ZIP LODI CA 95240 LICENSE I C-42 I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y Id PERC TEST #31§UILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: II RESIDENCE II COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY 931 #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE it ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it ❑ FILTER BED WIDTH it LENGTH ft DEPTH it DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE it ❑ MOUNDED WIDTH ft LENGTH it DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE it ❑ SUMPS WIDTH ft LENGTH fl DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE it ❑ DISPOSAL PONDS WIDTH ft LENGTH 0 DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH fl DEPTH 1t DISTANCE TO NEAREST WELL it FOUNDATION fl PROPERTY LINE II 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 Woods Tamara TITLE STAFF SCIENTIST DATE 5-29-20 - SUN p? FO QC1 _ �FpMEtiCUN fa gRTMFNT DEPARTMENT U E ONLY �n Application Accepted By"'r �� Date v<' Area [t nr Employee ID# bA _ Final Inspection By Date SPE IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Date Parm iU Invoice# Permit ID# Code INFO ArN ash Remitted Servic a ueat# a sa3s� Ns� w 42.01 /n'f�, G/^/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 41418