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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 <br /> ]j EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 19113 Allen Rd. CITY/ZIP 1 t U i 1 S S <br /> CROSS STREET Carrolton 1{�` APN s 3 g�3 7 PARCEL SIZE Od <br /> OWNER NAME - d�� T' 7 !C�oW n Main S PHONE <br /> OWNER ADDRESS v BUY <br /> f � R401n CITY/STATE/ZIP <br /> CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATE/ZIP Manteca,CA 95336 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHERA NUMBER 608554 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: W-76 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM .❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:4 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG P&L Concrete CAPACITY 1600 gal #OF COMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL100+ ft FOUNDATION ft PROPERTY LINE 25 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH 25' ft LENGTH 38.5' ft DEPTH 18" ft <br /> DISTANCE TO NEAREST WELL 100+ It FOUNDATION 20 It PROPERTY LINE 20 fl <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 AD ANC -ICE REQUIRED FOR INSPECTIONS-PLEASE CALL 09 953-7697 <br /> SIGNED Mike Fuller TITLE Contractor DATE <br /> S e e a t t a c h e d <br /> DEPARTMENT USE ONLY u� H T O MFNTUN7)r <br /> Application Accepted G /l-l/�� Date Area -7 �"I Employee ID# A( <br /> Final Inspection By Data 1'65 ❑ SPECIAL PERMIT-Approved by FN]' <br /> Character of Soil to tDepth of 3 Ft: Pit/Sulmp�Soiill Character: <br /> COMMENTS /y(P�l a FR :11 et' t1/l c 2yY I 3 -� -x;2 sf ' <br /> PE Sc Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Re uest# <br /> Wd I 117I to <br /> S� 7 w <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />