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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 17767 Gretl Ct.///�yyyy CITY/ZIP Ripon,CA <br /> CROSS STREET IN ot—A Ala <br /> ��(�- APN :a 3 2•n <br /> GT/� ,,/) r1 ,/� PARCEL SIZE Y <br /> OWNERNAME )C-t/" <br /> f •)r � �, "i"'c�� - + pl nC4(y (,J PHONE A �j <br /> OWNER ADDRESS y� but i� .% nL S�� �l L�Ce CITY/STATE/ZIP �I An IL Y1f 1 s--% <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATE/ZIP Manteca,CA 95336 <br /> LICENSE ----C-42 C=:C-36 OTHER A NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM 7 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:4 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG P&L Concrete CAPACITY 1600 gal #OF COMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 100+ ft FOUNDATION 5 ft PROPERTY LINE 75 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #of LINES 3 LENGTH OF LINES 50' ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 20 ft PROPERTY LINE 30' ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SUMPS WIDTH 2 ft LENGTH 12 ft DEPTH 10 ft <br /> DISTANCE TO NEAREST WELL 150'+ ft FOUNDATION 20 ft PROPERTY LINE 60 ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> MINIMCM 48 HOUR ADVANCE NOTICE REQUIREDP C S-PLEASE CALL(209)253-769 <br /> SIGNED Mike Fuller TITLE Contractor DATE <br /> M.°gQ�iH �Z'0 <br /> ----------------- <br /> Ty OP"V,N7-), <br /> �MENT <br /> DEPARTMENT USE 6INLY <br /> Application Accepted By Date Z "area Employee ID# <br /> Final Inspection By u Date 2D 2D ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: /� � �� Pit/Sump Soil Character: <br /> COMMENTS perrC- '�'�S-� JaAA— uMALW Mara G re� D <br /> IALY QY v D q <br /> V"1� ri 1%4k� 7d�� 12 <br /> PE SC Received eM-cRPrj I Amount Date Permit/ Invoice# Permit ID# <br /> oderi 211 INFO Remitted Service Re uest# <br /> I� g -2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />