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3 <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 A"+E.Avenue D 6,S'17 Avenue- D CITY/ZIP Manteca,CA 95337 � <br /> =1 <br /> CROSS STREET TWO RiversqpN 257-110-29 PARCEL SIZE.10,X13 d <br /> 0 <br /> OWNER NAME MOOtZ,Allen&Edith (� PHONE 209-275-2295 <br /> OWNER ADDRESS P-© 60x 0x CIN/STATEIZIP )Te J%1 c Q �.S (►f <br /> i <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2665 <br /> CONTRACTOR ADDRESS P.O.Box 650 CITY/STATE/ZIP Manteca,CA 95336 <br /> LICENSE ❑❑C-42 110C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#2000783 LAND USE APPLICATION# <br /> TYPE OF WORK: t NEW INSTALLATION ❑ REPAIR/ADDrnON 7 ENGINEER DESIGNED/ALTERNATIVE <br /> F1 REPLACEMENT Fl OUT-OF-SERVICE SEPTIC SYSTEM -1 DESTRUCTION <br /> INSTALLATION WILL SERVE: Jar RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:1 NUMBER OF BEDROOMS:2 NUMBER OF EMPLOYEES: <br /> a( SEPTIC TANK TYPE/MFG P&L Concrete CAPACITY 1200 gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELLI OO ft FOUNDATION 10 ft PROPERTY LINE 60+ It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ii LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTERBED WIDTH 15' ft LENGTH 32' It DEPTH 18" ft <br /> DISTANCE TO NEAREST WELL 100' It FOUNDATION 10 ft PROPERTY LINE 50+ ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE Y <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH �i CNr <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE CCC <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH <br /> ��l <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEft os <br /> ❑ SEEPAGE PITS NUMBER WIDTH DEPTH / n <br /> DISTANCE TO NEAREST WELL ft Oo <br /> FOUNDATION ft PROPERTY LINE �{t^ G `/ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY t�RnQY /N CQ <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. /7 D MEDT UNT y <br /> QR <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 TMENT <br /> SIGNED Mike Fuller TITLE Contractor DATE 4/3/2020 <br /> S e e A t t a c h e d <br /> Application Accepted �{� DEPARTMENT DU A ONLY Area �� Employee ID# IN <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit Sump Soil Character: <br /> COMMENTS Fate, eiwRtaae I g"a Ps A I <br /> Na -4filk o65"VIr t IfIAn the prdys}ewr per fAu»}}/ <br /> 1C'L0rd. <br /> PE SC Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Remitted Service Re uest# <br /> c I L1 lzo S5" 10 1 w L <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />