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1r <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />I ION-KEFUNDABLE PERMIT (;ALL (LUy) YDJ-/DVI FOR INSPECTIONS tXPIRES 7 TEAR FROM UATE ISSUE <br />JOB ADDRESS 14762 S. Airport CITY/ZIP Manteca 95336 <br />CROSS STREET Lathrop Rd APN r) C) j I Z) Od 0 PARCEL SIZE I <br />OWNER NAME Fairway Land Holding Company, LLC PHONE 925-383-9066 <br />OWNER ADDRESS 32008 Wycliffe Dr CITY/STATE/ZIP Modesto, Ca 95355 <br />CONTRACTOR Modesto Sand and Gravel, Inc. PHONE 209-545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct <br />LICENSE ❑CC -42 0[ C-36 OTHER C-12 C-21 <br />CITY/STATE/ZIP Modesto, Ca 95358 <br />NUMBER 271166 EXPIRATION DATE 2/23 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERN IVE <br />❑ REPLACEMENT L1 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br />INSTALLATION WILL SERVE: ❑ RESIDENCE L] COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />❑ <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Permit ID# <br /># OF LINES <br />07S' <br />LENGTH OF LINES ft <br />ls� <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft 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 LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft 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 />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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />OW1813ppWIF1Yt �V�n11 VR LJYNI•VC 111V i VC RC VI G✓ rV IIrJrGV 11 IBJ - rLGMJlL V/'iLC LV,7.7 -I.wJl <br />SIGNEDr V�i�' �'( TITLE Project Manager DATE �/7 Z-4 1 Z' <br />DEPARTMENT U E ONL <br />Application Accepted By r Z% Z— Date a Area S Ci Employee ID# <br />Final Inspection By Date /o- �� ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS I r- ruC ),n bF f p t;c �,-I, 5. <br />PE <br />Code <br />Sc <br />INFO <br />Received (-CheckW <br />B sh <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />yap 1 <br />07S' <br />p <br />ls� <br />5 z't <br />S3 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />