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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 10966 E.MARIPOSA ROAD CITY/ZIP STOCKTON N <br /> m <br /> CROSS STREET KAISER APN 181-060-09 PARCEL SIZE 1.25 e <br /> 0 <br /> OWNER NAME ARRIAGA PHONE 209-323-0904 y <br /> Vi <br /> OWNER ADDRESS 10966 E.MARIPOSA ROAD CITYISTATE/ZIP STOCKTON,CA 95215 <br /> CONTRACTOR TERRACON CONSULTANTS INC/AARON MEJORADO PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI,CA 95240 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06-30.2022 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #2 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> rl REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM -1 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 TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES i i LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br /> 1 I <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH D <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE !ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH AO O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY L&4 At ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUI SGS <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. LTH D SCOL"Ty <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697RP4RTMVNT <br /> SIGNED TITLE STAFF SCIENTIST DATE 07-16-2020 <br /> oo a .� <br /> K <br /> (. . <br /> 3EtTj <br /> a <br /> -- -- -- — <br /> N .--- •�-•—•••�•--•- - pIL4AnItIN! 1 <br /> MM <br /> `{ <br /> ' I <br /> QI !OY ISP <br /> DEPARTMENTUSE ONLY <br /> IT <br /> Application Accepted y l_ Date #? 1 Area I q� Employee ID# S� <br /> Final Inspection By l V J Date ❑ SPECIAL PERMIT-Approved by <br /> B <br /> Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS _CSAR.S Sf4b0Vq�--MSV re,ui 'e� SCI BY1 U�rr <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remitted Service ReAgest# <br /> 9.1 2d 5a3fkiSa-- 3� <br /> 42-01 2— <br /> / //,I I, ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 T(. /// L/ !/``J L'�.l/�- <br />