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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 22909 Currier Dr. Cm/ZIP Tracy,95304 � Hansen Rd l0� �� 3 > CROSS STREET APN P ( PARCEL SIZE C OWNER NAME Adrian Gomez PHONE(510)780-6432 m OWNER ADDRESS 22909 Currier Dr. CITYISTATE21P Tracy,Ca 95304 CONTRACTOR Garcia&Son's Construction PHONE(209)238-3986 CONTRACTOR ADDRESS 1101 7th Street CITY/STATE/ZIP Modesto,Ca 95354 LICENSE I I C-42 I I C-36 OTHER B NUMBER 955676 EXPIRATION DATE 12/20 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I_I COMMERCIAL I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH Z� ft LENGTH It DEPTH 1 _ ft DISTANCE TO NEAREST WELL-hj/3r ft FOUNDATION IT It PROPERTY LINE I ft 0 MOUNDED WIDTH ft LE TNG H ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 X9553-7697 SIGNED iL TITLE 1 L�,' ri DATE 9)1 2 R qY� CyViROI Na cFi�Ny� SP o cos Fo if R ,, 01000o°F gRFT - MFNT DEPARTMENT USE ONLY �- 1_ sArea S X Application Accepted �, Date � Employee Final Inspection By Date PECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sum7S.Si araC,COMMENTS� S"f?W i �i�� . t1.5 Sfr•rn ',L Nli� �JJ1 n%i !PI on IC(JfCa u" C G; i✓. C C Z be i v� a PE SC Received Check#/ Amo nt Date Permit/ Invoice# Permit ID# Code INFO Cash Remitted Service Reguest# L)�1J 3vJ S Z) St2. Off( X2.7 ve� 42-01 ONSITE W ER TRTMNT SYSTEM PERMIT WASTE 4//14/14/18 dl..e fo to rtEt�t n/ sA I.