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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 (LUU) 9bJ-/6y/ FOR INSPECTIONS LXPIRES 'I TEAR FROM DATE ISSUE <br />JOB ADDRESS 17394 Front St. CITY/ZIP Linden, CA <br />CROSS STREET Archerdale APN 091-130-17 PARCEL SIZE 1.26 <br />OWNER NAME Rocky Guadagnolo PHONE209-986-6769 <br />OWNER ADDRESS 17394 Front St. CITY/STATE/ZIP Linden, CA, 95236 <br />CONTRACTOR Terracon PHONE 209-367-3701 <br />CONTRACTORADDRESS902 Industrial Way CITY/STATE/ZIP Lodi, CA, 95240 <br />LICENSE C-42 C-36 OTHER C-57 NUMBER669004 EXPIRATION DATE 5/31/2021 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />X PERC TEST # 2 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: X RESIDENCE COMMERCIAL . OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 2 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 LEACHING CHAMBERS <br /># OF LINES <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ FILTER BED WIDTH <br />ft <br />LENGTH <br />ft <br />DISTANCE TO NEAREST <br />L3MOUNDED �'WIDTH <br />WELL <br />ft <br />LENGTH <br />ft <br />FOUNDATION <br />ft <br />DqNCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ S <br />ft <br />LENGTH <br />ft <br />� STANCE TO NEAREST <br />lklanr4PONDS <br />WELL <br />ft <br />FOUNDATION <br />(3 WIDTH <br />1 <br />ft <br />LENGTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ S PAGE PITS NUMBER <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />LENGTH OF LINES _ <br />ft PROPERTY LINE <br />DEPTF <br />ft <br />DEPTF <br />ft <br />DEPTF <br />ft <br />DEPTF <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <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 />MIMMUM48H R ADVANCE NOTICE REQUIRED FOR /NSP TI N - PLEA E CALL L209) 953-7697 <br />SIGNED✓,'titil 1 �� ,j' �r� .k .}3 .I TITLE .�k r_:,'� DATE <br />Application Accepted By� <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />Date <br />Pit/Sump Soil Character: <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />—L <br />Employee ID# <br />PERMIT - Approved by <br />rtq'� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />