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t <br /> 1 <br /> r <br /> 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 3928 Stoneridge Dr. CIN/ZIP Tracy,CA y <br /> CROSS STREET Grantline Rd. APN 3 9a so 17 PARCEL SIZE i I q S <br /> OWNER NAME �e d We I I F r r IZP♦7e i /��'�''���r G PHONE <br /> G � <br /> OWNER ADDRESS SGI W)` CITY/STATE/ZIP <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.Box 650 CITY/STATE21P Manteca,CA 95336 <br /> LICENSE ❑❑C-42 ❑-C-36 OTHERA NUMBER 608554 ExPIRATION DATE 2020 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION W REPAIRIADDITION ❑ ENGINEER DE31ONLD/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OFSERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK /I �1`YPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES l LEACHING CHAMBERS III OF LINES 1 LENGTH OF LINES-4w It <br /> 77-7 <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 10 ft PROPJFRTY LINE 25 R <br /> p FILTER BED WIDTH ft LENGTH. It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIOrji.,W It PROPERTY LlDllI ft <br /> ❑ MOUNDED WIDTH It LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 41 - LJDISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED Mike Fuller TITLE Contractor DATE 8/12/2020 <br /> T <br /> IA <br /> D <br /> S <br /> 0 <br /> '7C - <br /> i <br /> A T T <br /> DEPARTMENTUS E ONLY <br /> Application Accepted By /� Date U Area % Employee ID# S� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/ u Soil Character: <br /> COMMENTS Y C h nes. f 'VIP' 1'h )ti Y 7 d�d� t� <br /> joiecj w a i l cciLind. qh 60 *f Jgej4l e CIZo b <br /> PE SC Received Chec Amount Permlu Invoice# Permit ID# <br /> Code INFO B sh Remitted at Servic Re uest# <br /> alp its 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />