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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />19UN-r%tI-UNLJAIJLt r'tKMI I CALL <br />JOB ADDRESS 2375 Lower Sacramento Road <br />CROSS STREET _Harney Lane <br />OWNER NAME FCB Homes <br />OWNER ADDRESS 10100 Trinity Parkway #420 <br />CONTRACTOR Modesto Sand and Gravel, Inc. <br />UDJ-/OV/ FOR INSPECTIONS tXPIRES "I YEAR FROM DATE ISSUE/ <br />CITY/ZIPLLoddi 95242 <br />V <br />APN QS_9(_)C1 0 01 <br />`PARCEL SIZE <br />PHONE 925-768-3545 <br />CITY/STATE/ZIP Stockton, Ca 95219 <br />PHONE 209-545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STATE/ZIP Modesto, Ca 95358 <br />LICENSE ❑ IC -42 ❑i 'C-36 OTHER C-12 C-21 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: NEW INSTALLATION it REPAIR/ADDITION I l ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION Septic Tank <br />INSTALLATION WILL SERVE: ❑ RESIDENCE 7 COMMERCIAL F OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES i7 LEACHING CHAMBERS # OF LINES LENGTH OF LINES 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 REGULATIONS OF SAN JOAQUIN COUNTY. <br />DEPARTMENT USE ONLY <br />DEPARTMENT.US5 ONLY !� <br />Application Accepted y �/� Date Area 1 Employee ID# <br />Final Inspection ByEl Date SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS z6ki6< L,lkn0,jii eft jj1 w bfIroif ISSyPGr' 14,;Pip fo .6e r.1pi_,7v1lshvol <br />PE SC <br />Code INFO <br />DISTANCE TO NEAREST <br />WELL <br />�-) as � ops' <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />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 <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />It PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />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 <br />LENGTH <br />ft <br />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 REGULATIONS OF SAN JOAQUIN COUNTY. <br />DEPARTMENT USE ONLY <br />DEPARTMENT.US5 ONLY !� <br />Application Accepted y �/� Date Area 1 Employee ID# <br />Final Inspection ByEl Date SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS z6ki6< L,lkn0,jii eft jj1 w bfIroif ISSyPGr' 14,;Pip fo .6e r.1pi_,7v1lshvol <br />PE SC <br />Code INFO <br />ReceivedCheck#/ Amount <br />B Cash Remitted <br />Permit/ <br />Date Service Request # Invoice # Permit ID# <br />�-) as � ops' <br />� / <br />21 21 5 00 W l <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />