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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 />NON-KEFUNDABLE PERMIT GALL LU19 19bJ-1619/ FOR INSPECTIONS r-XPIRES l TEAR FROM DATE ISSUEI <br />JOB ADDRESS 10283 E Brittany Lane CITY/ZtP Acampo, 95220 <br />CROSS STREET Bryant Road APN 007-070-49 PARCEL SIZE 4.85 <br />OWNER NAME Nelson MDrgado PHONE 209-329-7568 <br />OWNER ADDRESS 678 Tallega Ct. CITY/STATE/ZIP Galt, CA <br />CONTRACTOR Petralogix Engineering, Inc. PHONE 209-329-7568 <br />CONTRACTOR ADDRESS 26675 Bruella Road CITY/STATE/ZIP Galt, <br />CA 95632 <br />LICENSE [ II IC -42 ❑I IC -36 OTHER PG NUMBER 8657 ExPIRATION DATE.,Iv/H 9 f 30b 3 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X - Ilk • Y <br />PERC TEST # <br />1 BUILDING PERMIT # <br />Permit/ <br />ate Involve # Permit IDN <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />CI NEW INSTALLATION I i <br />REPAIR/ADDITION <br />I ENGINEER DESIGNED /ALTERNATIVE <br />ft FOUNDATION <br />I I REPLACEMENT I I <br />OUT -OF -SERVICE SEPTIC SYSTEM i DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />I I OTHER <br />LENGTH <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />DEPTH ft <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 />WIDTH <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 <br />LEACHING CHAMBERS <br />Check#/ <br /># OF LINES <br />Permit/ <br />ate Involve # Permit IDN <br />LENGTH OF LINES ft <br />INFO <br />DISTANCE TO NEAREST <br />WELL <br />$rvice Reo <br />ft FOUNDATION <br />sa3Sy� <br />ft PROPERTY LINE ft <br />❑ FILTERBED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />DEPARTMENT US d ONLY <br />Application Accepte Date Area qP4 F Employee ID# r Z <br />Final Inspection By '17DateW- V ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to 6epth of 3 Ft: U0410411l Pit(Sump Soil Character: <br />COMMENTS ftf,4l "111 =MCk <br />PE <br />SC Received <br />Check#/ <br />Amount <br />Permit/ <br />ate Involve # Permit IDN <br />Code <br />INFO <br />r <br />Cash <br />Remitted <br />$rvice Reo <br />aaa <br />sa3Sy� <br />,�n, <br />t <br />42-01y ! � l/ -3 L � ? -<-ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4124/12 <br />