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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 10406 Southland rd CITY/ZIP Manteca,CA 95336 v <br /> ((��¢ 4 <br /> CROSS STREET Austin Rd. APN DI VV O7 oo2 PARCEL SIZE �• 6 <br /> 0 <br /> m <br /> OWNER NAME Otnesy a Pf VG1 S>" A 1'f�j D^C/ A­-- <br /> PHONE77 <br /> OWNER ADDRESS ISI 1 S,�I GGYI f Y 14 A CITY/STATE/ZIP A­_ S(e )0( 1 <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2565 <br /> CONTRACTOR ADDRESS P.O.Box 650 CITY/STATE/ZIP Manteca,CA 95336 <br /> LICENSE E C-42 ❑ C-36 OTHER A NUMBER 608554 EXPIRATION DATE 2020�� <br /> WATER TABLE DEPTH: LID- ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION NGINEER DESIGNEDIALLTERNATIVE <br /> REPLACEMENT C,C� I. OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION f}G1 V)/ <br /> INSTALLATION WILL SERVE: PARESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: <br /> U SEPTIC TANK TYPE/MFG P&L Concrete CAPACITY 1200 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 100 it FOUNDATION 40 ft PROPERTY LINE 5 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES .. LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINES 60' ft <br /> DISTANCE TO NEAREST WELL 100 (t FOUNDATION 60 it PROPERTY LINE 5' ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION (I PROPERTY LINE It <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �UMPS WIDTH 2' ft LENGTH 12' It DEPTH 10' ft <br /> DISTANCE TO NEAREST WELL 150 ft FOUNDATION 80 It PROPERTY LINE 5 it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 <br /> S e e a t t a c h e d <br /> T <br /> DEPARTMENT SE ONLY )�(� <br /> Application Accepted Date I8 V U O Area J/ 7 —1 Employee ID# (7 I-7 to 7 O <br /> Final Inspection By Date - SPECIAL PERMIT-Approved by v— <br /> Character of Soil to Depth Th <br /> 3 Ft: Pi/Std Ip Soil Character: <br /> COMMENTS F I�I h4 5� �P�'{rl Ti v I /�o vJP 1< , ( �i5l GALA tIr J2 <br /> 1'�eC0 fds.� <br /> PE SC*Received Amount Permit!Code ICash Remitted Date Service Request# Invoice# Permit ID# <br /> ydla E!1 <br /> 3 <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />