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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:II/IGI, t^^CITYilJP W CROSS STREET /'/7 �rs s n 1�� APN Da I - 6D )L:' ) kA PARCEL SIZE OWNER NAME %'l?HY1 S��l ��C1le -5 !-sl rll lPe 9 PHONE OWNER ADDRESS LL- 0 C 1 .'.1:.1 S>) CITY/STATE/ZIP 7!, rj I CONTRACTOR TERRACON CONSULTANTS INC. / AARON MEJORADO PHONE 209-367-3701 CONTRACTOR ADDRESS 902 INDUSTRIAL WAY LICENSE ❑ 7C-42 ❑.'C-36 OTHER PE 72446 CnvISTATEIZIP LODI, CA 95240 0 06/30/2022 WATER TABLE DEPTH: 11A PERC TEST 03 TYPE OF WORK: _ _ NEW INSTALLATION REPLACEMENT ft GEOGRAPHICAL INFORMATION: Coordinates X Y BUILDING PERMIT -# LAND USE APPLICATION # _ REPAIR/ADDITION _ ENGINEER DESIGNED IALTERNATIVE OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Permit/ �„ y Service Re Invoice cAfj^ INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 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 _........... It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES - LEACHING CHAMBERS #OF LINES LENGTH OFLINEs ft DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTYLINE_ ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE it ❑ MOUNDED WIDTH R LENGTH R DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE it ❑ SUMPS WIDTH R LENGTH it DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYLINE it ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE _ ft ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION /t PROPERTY LINE it 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. !�� DEPARTMENT �/ J� Application Accepted By �` Date �2 Z J 2 I Area l tt'' �r C EmployA ID# Y �) Final Inspection By Date ❑ SPECIAL PERMIT - ADD e Character of Soil to Depth of 3 Ft: PIUSump Soil Character: R COMMENTS A PE Code $C Received INFO 8 Amount Cash Remitted Date Permit/ �„ y Service Re Invoice cAfj^ uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 411a1e tv