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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 2690,Hansen Road(see map) CITY/ZIP Tracy,CA 95377 tp <br /> -4 <br /> m <br /> CROSS STREET None APN 209-110-100-OW PARCEL SIZE "38—S D <br /> 0 <br /> 0 <br /> v <br /> OWNER NAME Costco Wholesale PHONE(425)313-6052 H <br /> OWNERADDRESS 999Lake Drive /� CITYISTATE/ZIP IsSaQuah,WA98027 <br /> CONTRACTORS GorSkt� G'LCN. A✓7�✓r �^,��i PHONE (209)469-7700 <br /> CONTRACTOR ADDRESS 3806 Duck Creek Drive L )AA''t�CITY/STATE/ZIP SIOCkWI,,CA 95215 <br /> LICENSE Fl. C-42 7 C-36 OTHER'_ NUMBER399�0�4 E(I SN OEXPIRATION DATE A r 22 ,Sure 30 ;02a <br /> WATER TABLE DEPTH: 100 ft GEOGRAPHICAL INFORMATION: Coordinates X 21.'09269 Y 121 0144,5 <br /> X 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 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY _ - _ gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS _ <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKGTX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L] LEACH �/LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES 'ft14 r MEA' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE RfECFIVI`v <br /> El FILTER BED WIDTH ft LENGTH ft DEPTH fl L 1L�D <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. <br /> LJW V 2 MOUNDED WIDTH ft LENGTH ft DEPTH UG <br /> 5 2020 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> Ll sumps WIDTH ft LENGTH ft /P DEPTH `fQAQUIN COUNTY' <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE N AI I,9CNMENr <br /> DISPOSAL PONDS WIDTH ft LENGTH DEPTH I�DERAR A <br /> Ll DISPOSAL D <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I T'^Y' N <br /> E'v� <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I I IEREBY 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE E"°'ronmentalScientist-Klelnlettler,Inc. DATE 08i2v2620 <br /> DEPARTMEN US ONLY ` <br /> Application Accepted By `/w� � Date J 0 Area S Employee ID# J _ <br /> Final Inspection By f~—.4 ��'Y� Date !u ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B ce- Cash Remitted DateRequest# Invoice# Permit ID# <br /> (loki 4 <br /> <,J <br /> t[U I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> !lZ9GSIo9 <br />