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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 FORINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 26254 E River Rd �!`j � CITYILP/1Escalon n <br /> CROSS STREET McHenryAvenue APN A I 1 u l� PARCEL SIZE a D' o <br /> f/ e <br /> OWNER NAME AddarrRanch �t PHONE 209-596-6895 y <br /> OWNER ADDRESS 26554E-Rive c&d I� �,,v CITYISTATEMP Escalon,Ca 95320 <br /> CONTRACTOR Modesto Sand and Gravel,Inc. PHONE 209-545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STATEIZIP Modesto,Ca 95358 <br /> LICENSE L C-42 1.1 C36 OTHER C-21 NUMBER 271166 EXPIRATION DATE 2/21 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br /> INSTALLATION WILL SERVE: L RESIDENCE II COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSEDN1-` <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE To NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH 4 020 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH JO ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE w __VI (]jU11" UNTY <br /> ❑ SUMPS WIDTH it LENGTH It DEPTH —rT'cLOALTH DF�A4, 7' AL <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ENT <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 SEEPAGE PITS NUMBER WIDTH ft 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. hh <br /> 48 HJ2VB ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9,U-76R <br /> SIGNED y TITLE Project Manager DATE V <br /> �-, DEPART MEN USE ONLY <br /> �G z-� Date 1/ � v U Area �I Em ee ID# <br /> to <br /> Application Accepted y p y <br /> Final Inspection By Date % L SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Phisump Soil Character: <br /> COMMENTS Ifl�J) �o 11^. t'/l✓ I ;i <br /> AaAY' <br /> 0 o A.S, <br /> PE SC Received Chec Amount to Permit/ Invoice# Permit ID# <br /> Code INFO S Remitted Service Requwt <br /> �d 1 7s 1561 U2, <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />