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t 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 16588 Los Positas way CITY/7jP Tracy,CA CROSS STREET Hansen Rd. n /� APIN 41 ':7 PARCEL SIZE 11 P, e OWNER NAME ��t.�/� +✓C 1/1 7,/��/ kc 4- �'r'Cfp,�C P/H�ONE �1 � OWNER ADDRESS I 1 nl n f3 L N-J `]k`•`-A 1 CITY/STATE/ZIP ,l I:C.- 7 /C.4 CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 CONTRACTOR ADDRESS P.O.BOX 650 CITY/STATE/ZIP Manteca,CA 95336 LICENSE [:,--C-42 E-C-36 OTHHEER A NUMBER 608554 EXPIRATION DATE 2020 WATER TABLE DEPTH: 3,457 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # 7-1 BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: n EW INSTALLATION t❑ REPAIR/ADDITION F1 ENGINEER DESIGNED/A TERNATIVE EPLACEMENT�, L^ +j 4111'[1 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 3 n CAPACITY dDO O gal #OF COMPARTMENTS_e2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 100+ ft FOUNDATION 5 ft PROPERTY LINE 5 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 29' ft LENGTH 41¢,5 ft DEPTH 181, ft DISTANCE TO NEAREST WELL 100+ It FOUNDATION 10' ft PROPERTY LINES It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH fl LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED Mike Fuller TITLE Contractor DATE -�, -� Nit Sep oqQ�s 4?0,?o A 660-909 1 1 VjR /N�O NT EPARTMENTUSEONLY Application Accepted Date Area Employee ID#��r l a- Final Inspection By Date IZ 12 11SPECIAL PERMI -Approved by Character of Soil to De of 3 Ft: PIU ump Soil Chara ter: COM [NTS C C�"f lGY1 a e _ N 2 2i- VC, -to fid._ oiIJL d; wr4kll PE SC Received Check Amount t/ Date Permit/Code Invoice# Permit ID# Code INFO B Remitted Service Re uest# -- IZ O 2 7 42-01 IVl7�roNV r -fo le. f 01 t.P 4/14/15 Ce1imc )'n � \V` ONSITE WASTEWATER TL�RITMN\Tu SYSTEM PERMIT � i DP/7 P7 w"V �'✓ ��.