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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2300 S MACARTHUR DRIVE CITY/ZIP 95376 v, =i m CROSSSTREET VALPICO APN 25205005 PARCELSIZE 1.3 ACRES c 0 OWNER NAME SAM MUADDI PHONE 408-391-8099 OWNER ADDRESS 1111 W EL CAMINO REAL SUITE 133-119 CITY/STATE/ZIP SUNNYVALE CONTRACTOR DANS PLUMBING PHONE 209-404-8838 CONTRACTOR ADDRESS 1512 PRAIRIE DOG DRIVE CITY/STATE/ZIP MODESTO CA 95355 LICENSE ❑ C-42 C-36 OTHER C36 NUMBER 850085 EXPIRATION DATE 11/30/2020 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION r ENGINEER DESIGNED(ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE C COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG N/A CAPACITY 1500 GALLONS gal #OF COMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MWWW 48 HO ADVAN061kO REQUIRED FOR INSPECTIONS-PLEASE CALL 209)953-7697 SIGNED C TITLE OWNER DATE 8-3-2020 C O N N E C T I NIGI I T 1 O CIII TIYI IS EIWIEIRI JA N D INI E I E I D T O B A C K F IILI LI ITIH E SI E I P I T I C I T A N K I I I I I /1 I�v�yMF Fid or G 0 pgRT q�j'vTY MFHT Qaff ARTMENT USS ONLY Application Accepted Date Area (yEmployee ID# Final Inspection By Date _ SPE IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soi haracter: C MMENTS W7t p� ( lonCY� PESC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Request# S'�-w C;<003201z 42-01 (// ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118