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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAzELTGN AVENUE-STocK70N CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 26850 Lower Sacramento Road CRyZp Galt/95632 <br /> CROSS STREET Highwayy 99 APN 005-030-07 and 005-020-02 PARCEL SIZE 78.8 Ac. b <br /> d <br /> OWNER NAME Ventana Development,c/o Frank Schmidt PHONE(510)468-9219 <br /> OWNER ADDRESS 17975 Deer Run Ct./55 S.Market CrtY/STATEZP Morgan Hill,CA.95037/San Jose <br /> CONTRACTOR Dillon&Murphy PHONE(209)334-6613 <br /> CONTRACTOR ADDRESS P.O.BOX 2180 CITY/STATE/ZIP Lodi/Ca/95241 <br /> LICENSE 11-_C42 0_C36 OTHER NUMBER ExPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATKIN: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#PA 0600074 <br /> TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES _ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I 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 /> I48MUR ADVANCE NOTICE REQUIRED I NS-PLEASE CALL 7 <br /> T �2t L J;JrLU <br /> SIGNED TITLE ✓C�a�,(I"1/C-f,tT�" DATE <br /> r <br /> 20 <br /> DEPARTMENT SE ONLY NT <br /> Application Accepte;epth <br /> Date .> �Q Area L Employee ID# D <br /> Final Inspection By Date LlSPECIAL PERMIT-Approved by <br /> Character of Soil to of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Chec Amount Date PermiU Invoice# Permit ID# <br /> Coda INFO B Cash Remitted Service Re uest# <br /> baa s�3 0 3lsa ° <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />