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I <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />rYUIWRtt-UIVUA13Lt YtKMIT <br />JOB ADDRESS 641 Hamey Lane <br />CROSS STREET Lower Sacramento Rd <br />OWNER NAME FCB Homes <br />OWNER ADDRESS 10100 Trinity Parkway #420 <br />CONTRACTOR Modesto Sand and Gravel, Inc. <br />CONTRACTOR ADDRESS 6137,Hammett Ct <br />LICENSE ❑1 IC -42 DIIC-36 OTHER C-12 C-2' <br />CALL <br />.90J -/6y/ FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUEI <br />CITYIZIP Lodi 95242 <br />v <br />APN OQ O Qq D)-3 PARCEL SIZE <br />PHONE 925-768-3545 <br />CITY/STATE/ZIP Stockton, Ca 95219 <br />PHONE 209-545-4425 <br />CITY/STATE/ZIP Modesto, Ca 95358 <br />NUMBER 271166 EXPIRATION DATE 2/23 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />L PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: I_i NEW INSTALLATION I.1REPAIR/ADDITION IENGINEER DESIGNED /ALTERNATIVE <br />f I REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM x DESTRUCTION Septic Tank <br />INSTALLATION WILL SERVE: f RESIDENCE h COMMERCIAL n OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Received Check#/ Amount <br />Py Cash Remitted <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />7s <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH ' <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <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 <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />DEPARTMENT USE ONLY <br />D E PA RT <br />Application Accepted By Date <br />M q -U SONLY <br />d Area % -CA Employee ID# " <br />Final Inspection By� K -6f-*— Date .— -y ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: PiVSump Soil Character: <br />COMMENTS o YNP rJ 6 demo 14h <br />CF - <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ Amount <br />Py Cash Remitted <br />Date <br />I I I <br />Permit/ Invoice # Permit ID# <br />Service Request # <br />7s <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />