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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 20978 S. Carrolton Road CITY21P Ripon, CA 95366 CROSS STREET Mello Avenue APN 245 -120 -ICI PARCEL SIZE 20.00 OWNER NAME Santiago Gutierrez PHONE (209) 602-6569 OWNER ADDRESS 6148 Chickasaw Court CrrY/STATEZP Manteca, CA 95336 CONTRACTOR Baez Geotechnical Grou, Inc. PHONE (209) 602-6569 CONTRACTOR ADDRESS P.O. BOX 296 CITY/STATEZP Oakdale, CA 95361 LICENSE El -;C-42 11 -C-36 OTHER William Stevens, PE, GE NUMBER CE 43010/GE 2339 EXPIRATION DATE 3/31/1022 WATER TABLE DEPTH: 25 ft GEOGRAPHICAL INFORMATION: Coordinates X 37.769942° y -121.066187° 9 PERC TEST # h BUILDING PERMIT # WELL LAND USE APPLICATION # TYPE OF WORK: i NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE ft DEPTH ft REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ._ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: O SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS O GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft DEPTH ft DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) O LEACH LINES 11, LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft O SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT 1 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. M/AlIMIIM dR /-1r1111D dAVd N/`F A/ATI/`F RFnIIIAFt) FAR /A/CPF/`TIANR _ PI Fd.CF (`dl 1 /94101 05 Q_7R07 SIGNED President DATE 3/31/2022 AA. DEPARTMENTU EONLY Application Accepted By L Date 141jZ,2a Area S Employee ID#A cy Final Inspection B Dat 1 -.Xi❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: \ Plt/Sump Soil Character: COMMENTS P�CQ-� �PC�r S -S �o r-./n�..�ta.� 10�.r ►�L 1,. ` PE SC Received Check#/ Amount Da Permit/ Invoice # Permit ID# Code INFO Cash Remitted Service Request # /aaa sa3 1� 42-01 &4' l I 6 ! ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 r I