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:SSMIGOV 31IS 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 EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 18895 Lone Tree Road cirdzip Escalon 95320 <br />CROSS STREET Wagner Road APN 010 c 0 <br />PARCEL SIZE <br />OWNER NAME Doornenbal Dairy <br />PHONE 209-838-6282 <br />OWNER ADDRESS 19116 Lone Tree Road <br />CITY/STATE/ZIP Escalon Ca 95320 <br />CONTRACTOR Modesto Sand and Gravel, Inc. PHONE 209-545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct <br />CITY/STATE/ZIP Modesto, Ca 95358 <br />LICENSE El E C-42 0 L C-36 OTHER C 12 C-21 NUMBER 271166 EXPIRATION DATE 2/21 <br />WATER TABLE DEPTH: <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br /> <br />D REPAIR/ADDITION <br /> <br />ENGINEER DESIGNED /ALTERNATIVE <br />L REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM <br /> <br />X DESTRUCTION Septic Tank <br /> <br />INSTALLATION WILL SERVE: rl RESIDENCE <br /> <br />COMMERCIAL <br /> <br />OTHER <br /> <br />NUMBER OF LIVING UNITS: <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br /> ft <br />L:1 LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES I' LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft 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 ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> ft <br />- - <br />I HEREBY CERTIFY THAT I HAVE PREPARED TFIIS 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 />SIGNE <br />M IMUM 48 H(113 ADVANC4 NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />nita C tt TITLE Pro ect Manager DATE 01/22/21 <br />ev) <br />-- <br />••• • • es ••• es a., • so <br />Application Accepted By <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />Final Inspection By 1)-7C),---/\._,'----. Date 01 1 7- C I I- 1 0 SPECIAL PERMIT -Approved by <br /> <br /> <br /> Date /4701 /8 7 Area <br /> L/ /g' Employee ID# DA, <br />DEPARTMENT U S E ONLY <br />COMMENTS i)(-,5+ / L.,,. J- /‘.,' I-) .-. ( )-,-,11 k (1,-,5,De. i ('-teri v.) . )12 pe lig" I' n Li r'114' <br />'4c.e,i (tea 0- Otis ,ec, o c-- &rap 10-ocr‘ ctool evyylo litc6pf--, IVB \sx <br />• <br />PE <br />Code <br />SC <br />INFo <br />Received <br />By <br />Check Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />/-* /;•• :f IS--• I (9'1124 SPOL-2)1Ci I?- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18