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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 />14UN-Kh1 UNUABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS 12958/12970 E lahant Road Cm/ZIP Acamoo. 95220 <br />CRoss STREET North Graham Road APN 007-270-22 PARCEL SIZE 4.59 acres <br />OWNER NAME Baltazar Morones <br />r� <br />pp PHONE <br />OWNER ADDRESS Same as above PO P�,c�,� 1 ,) D 1 CRY/STATEMP C41644 4 9S(232CONTRACTOR Petralogix Engineering PHONE 209-7700-00731 <br />CONTRACTOR ADDRESS 26675 Bruella Road Cm/STATE/ZIP Galt, CA 95632 <br />LICENSE - iI C-42 111 IC -36 OTHER PG NUMBER 8657 EXPIRATION DATE_ 4/302023 <br />ani ie Kramer <br />D <br />WATER TABLE DEPTH: <br />R GEOGRAPHICAL INFORMATION: Coordinates X -121.159122'W y 38.204143' <br />R PERC TEST # <br />2 BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />i NEW INSTALLATION I <br />REPAIRIADDmoN <br />I ENGINEER DESIGNED ]ALTERNATIVE <br />It FOUNDATION <br />- i REPLACEMENT I <br />OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />L.1 COMMERCIAL <br />_I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPEIMFG <br />CAPACrrY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE it <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION _ <br />ft PROPERTY LINE R <br />❑ UFT STATION <br />SIZE TYPE OF PUMP <br />0 PKG TX PLANT <br />] SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />L LEACHING CHAMBERS <br />#OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />--it <br />PROPERTY LINE it <br />❑ FILTER BED <br />WIDTH <br />R <br />LENGTH <br />it <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />it <br />LENGTH <br />it <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSALPONDS <br />WIDTH <br />It <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE To NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH _ _ It <br />DISTANCE TO NEAREST <br />WELL <br />R FOUNDATION <br />it PROPERTY LINE R <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 />ti <br />DEPARTMENT USE �O�f�LY <br />Application Accepted �� Date iJR �.1 Area Employee ID#F_ <br />Final Inspection By t %Lo C Date �( -+rYY 11 SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: PltlSump Soil Character: <br />COMMENTS <br />INFO <br />42A1 <br />4/24112 <br />Date <br />6l6/L, 2 L <br />Invoice # I Permit ID# <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />