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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 />IMON-KEFUNDABLE PERMIT GALL ZUhF YDJ-/OY/ FOR INSPECTIONS EXPIRES l TEAR FROM DATE ISSUE/ <br />JOB ADDRESS 2456 ESTATE DR. Crrv/ZIP STOCKTON 95029 <br />CROSS STREET THORTON RD APN 07202029 PARCEL SIZE •49 <br />OWNER NAME MIKE HARNACK PHONE 209-4719631 <br />OWNER ADDRESS SEE ABOVE CrrYISTATEMP <br />CONTRACTOR HALEY CONRACTING PHONE 209-463-2517 <br />CONTRACTOR ADDRESS 4228 NEWTON RD Cm/STATE/LP STOCKTON CA 95205 <br />LICENSE ❑ C42 G C-36 OTHER A,B,C16 NUMBER 580907 EXPIRATION DATE 11/30/23 <br />WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # I F BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION K REPAIR/ADDITION I ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE J COMMERCIAL l 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 />ALIFT STATION SIZE 4/10 HP TYPE OF PUMP see below ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />MYERS ME40 <br />LEACH LINES LEACHING CHAMBERS INFILTRATOR EO.36 #OF LINES 2 <br />LENGTH OF LINES 60' it <br />DISTANCE TO NEAREST WELL N/A <br />It FOUNDATION 10' <br />ft PROPERTY LINE 25 it <br />❑ <br />FILTER BED WIDTH It LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft' <br />❑ <br />SUMPS WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />It PROPERTY LINE ft� <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH fl�i <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />J <br />❑ <br />SEEPAGE PITS NUMBER WIDTH <br />It <br />DEPTH <br />DISTANCE To NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE AiQ� <br />l <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND <br />THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM48HCJR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br />SIGNED t—, 1 C <br />TITLE PROJECT MANGER <br />DATE 4 522 <br />0 <br />v <br />A <br />Application Accepted By - F V Date Area Employee ID#J V I V <br />Final Inspection�to <br />Data '? ZZ ❑ SPECIAL PERMIT - Approved by <br />tv <br />Character of Soep of 3 Ft: %IU5u Soll Chara ter: <br />COMMENTS tl L� t t Dq <br />G a <br />PE T SC ReceivedChec Amount PermlV Invoice # Permit ID# <br />Code INFO 8vw ash Remitted . Pa t% Service Reauest # <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />Mcly- <br />R 0 5 2022 <br />gQUIN COU <br />lvry <br />DEPART MINT <br />