Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT L.ALL(LUN) V0J-/0Y/ WK INJI•tG1/UN5 CAYIKLb "I TtAK I-KUM UA It 155Utl <br />JOB ADDRESS 23078 Greenleaf Road CITY/Zip Escalon 95320 <br />CROSS STREET Sexton Road APN o! y 701 PARCEL SIZE -U / Lo <br />OWNER NAME Kenneth and Margaret Roos PHONE 209-969-7016 <br />OWNER ADDRESS 1775 Ruth Drive <br />Modesto Sand and Gravel, Inc. <br />CITY/STATEZP Ripon 95336 <br />PHONE 209-545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STATE21P Modesto, Ca 95358 <br />LICENSE [1-C42 ❑_C$6 OTHER C-12 C-21 NUMBER 271166 EXPIRATION DATE 02/28/2023 <br />WATER TABLE DEPTH: <br />L PERC TEST # <br />TYPE OF WORK: <br />It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />BUILDING PERMIT # LAND USE APPLICATION # <br />.. NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br />INSTALLATION WILL <br />SERVE: L RESIDENCE <br />IJ COMMERCIAL <br />L OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />J LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE It <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />It <br />DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />It PROPERTY LINE It <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />it PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH It LENGTH <br />It <br />DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It 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 />TITLE Project Manager DATE Z 1 v;�- <br />���ti�����miiismmmI �Im Mmm===�������������ti��ti� • <br />���UNIME ��r <br />PE SC Received ec Amount Date Permit! Invoice # Permit ID# <br />Code INFO Bv Cash Remitted Service Request # <br />75' Z ISS 2 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />