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t <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-REFUNDAELE PERMIT CALL 209 933-7697 FOR INsPEmoNs EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 16294 E Spnng Creek Dr Crrv2P Rlpon195366 Y <br /> CROSS STREET %' 1!--'�. r'- l 1 261-230-29 <br /> �: APN PARCEL SIZE 12,701 sq ft,u� c <br /> OWNER NAME Boersma,Arvin&Theresa 209-5264142 °z <br /> PHONE <br /> OWNER ADDRESS 14265 Leroy AreCRY/STATEFLP Ripon,CA 95366 <br /> CONTRACTOR Modesto Kitchen&Bath Inc PHONE 209-526142 <br /> CONTRACTOR ADDRESS 1616 Tully Road CfTYlSTATE2IP Modesto,CA 95350 <br /> LICENSE .. C42 C-36 OTHER B C-6 NUMBER 1008245 EXPIRATION DATE 10/3112021 <br /> WATER TABLE DEPTH: Y; GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> LJ PERC TEST rl BUILDING PERMIT#B`I£-0s13 LAND USE APPLICATION# <br /> TYPE OF WORK: jk NEW INSTALLATR)N I REPAIRIADDmON I ENGINEER DESIGNED I}4TERNAT,MI,E <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:2 NUMBER OF EMPLOYEES' <br /> kS SEPTIC TANK TYP=JMFG P&L CAPACr1Y 1600 gal #OFCOMPARTLIENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION 129 ft PROPERTYLINE 70 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP D PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS 90FLINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTERBED WIDTH 76' 111 LENGTH 30' ft DEPTH 42 ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION136- ft PROPERTY LINE 10 IT <br /> ❑ MOUNDED WIDTH IT LENGTH ft DEPTH 11 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNC ft <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LIN- It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SANJOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN! HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 y� <br /> SIGNED TITLE111CS- Cr DATE <br /> I <br /> I I I <br /> I <br /> II I <br /> F FNT <br /> I I I V D <br /> 062020 <br /> I# NOV NT y <br /> I II gRTMENT <br /> I <br /> DEPARTMENT U <br /> Application Accepted By ` Date 7 <br /> .?E "J Area Employee IDM <br /> Final Inspection By Date i�L� L%C lQ ❑ SPECIAL PERYfi- pproved tIy <br /> Character of Soil to of 3 Ft: !,ArA j 0 Pittsump$oil Character: <br /> COMMENTS RQplc.L-t'W►i'^,'lj S FrN <br /> PE SC Received CheckB! Amount PerrmU <br /> Code INFO ash RemDale Remitted Service Re uest it Invoice II Permit ID# <br /> 41101 <br /> 4114118lo��s9�� <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> � <br />