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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-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS �j tXPIRES l YEAR FROM DATE 155UI <br />� <br />JOB ADDRESS 4741 Broughton Drive CITY/ZIP OTO "I G A <br />CROSS STREET Cole y // APN 0?S)ID0a PARCEL SIZE <br />OWNER NAME \ ijff re 1 1 r 1Ci i 1 L1 I N PHONE <br />OWNER ADDRESS 5 G Y►'I �- • CITY/STATE/ZIP <br />CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 <br />CONTRACTOR ADDRESS P.O. Box 650 <br />LICENSE C-42 'J C-36 OTHER A <br />Manteca, CA 95336 <br />NUMBER 608554 EXPIRATION DATE 2022 <br />WATER TABLE DEPTH: <br />It GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION REPAIR/ADDITION <br />ENGINEER DESIGNED/ALTERNATIVE <br />DISTANCE TO NEAREST <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 3 <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />it LENGTH <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />iS LEACH LINES LEACHING CHAMBERS # OF LINES 1 LENGTH OF LINES 40' <br />DISTANCE TO NEAREST <br />WELL n\a <br />ft FOUNDATION 10 <br />fl PROPERTY LINE 5' ft <br />FILTER BED WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />fl PROPERTY LINE It <br />❑ MOUNDED WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TD NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />:1 SUMPS WIDTH <br />it LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />fl PROPERTY LINE _ _ ft <br />❑ DI SAL PONDS WIDTH _ <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER 2 <br />WIDTH 36" <br />ft DEPTH 25' — fl <br />DISTANCE TO NEAREST <br />WELL n1a <br />ft FOUNDATION 10 <br />ft PROPERTY LINE 5' 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 <br />COUNTY. <br />MINIMUM 48 HOUR ADVANCE <br />NO E REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED Mike Fuller 14 <br />TITLE Contractor <br />DATE <br />DEPARTMENT U S E ONLY <br />Application Accepted B Date 9 Area l / �1 I Employee ID# drill f r <br />Final Inspection By �s Date SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of �Ft: Pit/ um Soil Character: <br />COMMENTS 0Y1Ue+e0't11y1e.Ter �It15�1�1L ll�ei }o rC'YVIC.,IYI. <br />PE SC Received Che Amount Date Permit/ Invoice # Permit IA# <br />Code INFO Remitted --sewice Bequest # <br />o Sao <br />42.01 <br />4/14118 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />