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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 />[1,IUN-rCtYUNUAt3Lt P'tKMI 1 <br />JOB ADDRESS 21001 North Elliott Rd <br />CROSS STREET Acampo Rd <br />OWNER NAME United States of America <br />OWNER ADDRESS 1400 Independence Ave <br />CONTRACTOR Wallace -Kuhl 8 Associates <br />CONTRACTOR ADDRESS 3050 Industrial Blvd. <br />CTIUNS tXPIRES T TEAR FROM DATE ISSUE <br />ITY/ZIP Lockeford 95237 <br />APN 051-210-390 PARCEL SIZE 15 AC and 105 AC <br />PHONE (202) 720-0536 <br />Washington D.C./ 20250 <br />PHONE (916)372-1434 <br />CITYISTATE/ZIP West Sacramento, CA 95691 <br />LICENSE .-. C-42 _ C-36 OTHER Professional Engineer NUMBER 57722 EXPIRATION DATE 12/31/21 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Y PERC TEST # 6 P—TPsls BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION _ REPAIRIADDITION ENGINEER DESIGNED (ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: I.. RESIDENCE I_. COMMERCIAL I_ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE ft <br />❑ FILTER BED <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 />It <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 It <br />❑ DISPOSAL PONDS <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 />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft 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 />Application Accepted ey�� <br />Final Inspection By�� <br />Character of Soil to Depth of 3 <br />COMMENTS gg"� <br />tmcrvr vow WIWI ■ <br />Date �Area � 1 Employee ID#�� <br />Date L SPECIAL PERMIT - Approved by <br />it/Sump Soil Character: 'l j <br />✓C' ^. <br />PE SC Received Check#I Amount ate Permitl Invoice # Permit ID# <br />Code? INFOO� B Cash Remitted Service Request # <br />ZZL Z -/ 4! C , <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <br />