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2_z2EPARTMENTOSI ONLY <br />Application Accepted Date rat? Area <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: (._7 Pit/Sump Character: <br />COMMENTS refC•te-Sk Ir0 <br />Employee ID# D A <br />Date 0/ J to 'Lo SPECIAL PERMIT - Approved by <br />2 V ic <br />trk <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZEL TON AVENUE - STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 23221 L Skiff Rd Lsca1on/95320 <br />CROSS STREET Bedefman Way ApN 205-190-62 PARCEL SIZE 12 07 Acres <br />OWNER NAME Matthew stump NONE (209) 505-9730 <br />OWNER ADDRESS 615 Janopaul Ln CITY/STATE/ZIP Modesto/CA/95351 <br />CONTRACTOR C I L CAL Inc PHONE (209)543-1799 <br />CONTRACTOR ADDRESS 4230 Kiernan Ave Ste 150 CITY/STATE/ZIP Modesto/CA/95357 <br />LICENSE C-42 C-36 OTHEF Geohcli 65-NUMBER c? 3 EXPIRATION DATE 6 /14242 <br />WATER TABLE DEPTH 25 ft GEOGRAPHICAL INFORMATION: Coordinates X 37 871483 Longitude y -1211)27320 Latitude <br />PERC TEST # <br /> <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 2 <br />OTHER <br />NUMBER OF EMPLOYEES: <br />0 SEPTIC TANK TYPE/MFG CAPACITY gal HOF COMPARTMENTS <br />0 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE S <br />0 LIFT STATION SIZE TYPE OF PUMP LI PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES LEACHING CHAMBERS /SOF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />01 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NurvBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT! 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED lea-kn-"/1ác4 LiTITLE Staff Geologist DATE 9/24/20 <br />A I. r. Ii <br />PE <br />Code <br />SC <br />INFO <br />Received Checleill <br />Cash <br />Amount <br />Rem itted Date <br />a <br />Permit/ <br />Service ReAuest # Invoice # Perm it ID# <br />LI dia a C ,23 <br />22_ <br />;---fr 41s-d. .41"4/36, crc'OCA4/ <br />42-01 <br />4/14/18 i6-2-3 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT