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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 26901 S.HANSEN ROAD '1,,Cl p CITY/ZIP TRACY 95377 <br /> W <br /> CROSS STREET SHULTE ROAD APN_Q /101() �S 3 <br /> PARCEL SIZE <br /> o i <br /> OWNER NAMECOSTCO WHOLESALE CORPORATION PHONE <br /> y <br /> OWNER ADDRESS 999 LAKE DRIVE CITYISTATEIZIP ISSAQUAH WASHINGTON 80202 <br /> CONTRACTOR KROEKER INC. PHONE 559-237-3764 <br /> ua. <br /> CONTRACTOR ADDRESS 9627 S.CHESTNUT AVE CITY/STATE/Zip FRESNO CA.9372.5 f <br /> LICENSE ❑LIC-42 ❑LIC-36 OTHER NUMBER �4 _EXPIRATION DATE. l>1)E t20�1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION Q ENGINEER DESIGNED/ALTERNATIVE <br /> U REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION SEPTIC DEMO <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 /> ® GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ------------ I <br /> ® LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTYLINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION �t PROPERTYLINE 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 /> /,{ <br /> MINIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE_1'iQ/�d 1!22AIC/L, DATE <br /> VNT <br /> EO <br /> o �?0 <br /> � cHTy <br /> FNT <br /> DEPARTMENT USE ONLY — <br /> Application Accepted By � <br /> y /1;:!!z Date_��„ ?'d^ Area Employee ID# DA <br /> Final Inspection By A . _ __ Date El❑ 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 Date Permit/ Invoice# . Permit ID# <br /> Code INFO By Cash Remitted I a Service Request# <br /> a a 1 0"7 r l sa 2`l <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />