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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 6301 W. Eight Mile Rd CITY/ZIP Stockton CROSS STREET Interstate 5 is 0.75 miles East of Site APN 055-280-0011ff PARCEL SIZE 20+ Acre OWNER NAME The Reserve at Spa— Park S / / PHONE 209-47B 7954 OWNER ADDRESS 11100 Tnnny Parkway. 5th Floor J k CITY/STATE/ZI S(]tocye�l n, C 95219 !' CONTRACTOR W xp o,eaUoTT' �- 7 I, (- rz PHONE ( 1 �" t 3 ^ k, 5 154G ROOsevelt.Aye. 3 G 1 1 L FscztafilCK(� X20 Yic't f CONTRACTOR ADDRESS--- - t',t. i a. rL L CITY/STAT �l I-� I t1 1'aN Sic. C - LICENSE C-42 C-36 OTHER NUMBER S7Q74� EXPIRATION DATE4"- WATER TABLE DEPTH: loft ft GEOGRAPHICAL INFORMATION: Coordinates X 38.058119 Latitude Y -121 386767 Longitude XI PERC TEST # 1 1 BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM4g HOV13ADVANCE NOTICE RE IRED FOR INSPECTIONS - PLEASE A SIGNED TITLE I °t `7r IC' i DATE %�G'l 1`I R d JTY NT unaracter Or aoU to ueptn OT v rt:a mP aoIn t.nardUWF: : COMMENTS ��' ,,—/' -4<G — l ✓: I) It )- / x IQ f' IVlv PE Sc Received Check#/ Am nt Date Permit/ Invoice # Permit ID# v Code INFO Cash emitted Service R uest # I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18