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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-NEFUNDABLE PERMIT L:ALL (LU9),9DJ-/b5/FOR INSPECTIONS tXPIRES 1 YEAR FROM UATE ISSUE JOB ADDRESS 21850 East Liberty Rd CITY/ZIP Clements 95227 CROSS STREET Hwy 88 APN () a 1 a o a a y PARCEL SIZE y, 9 OWNER NAME Yasir Khanshali PHONE 2096052370 OWNER ADDRESS 21850 East Liberty Rd CITY/STATE/ZIP Clements Ca 95227 CONTRACTOR Sun Valley Pumping PHONE 2096678010 CONTRACTOR ADDRESS 3319 S.TegnerRd LICENSE 117042 71-C-36 OTHER A CITY/STATE/ZIP Turlock, Ca 95380 NUMBER 731211 EXPIRATION DATE 01/21/2023 WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: L NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNF/AL ERNATIVE L REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE W COMMERCIAL ❑ OTHER 23 a NUMBER OF LIVING UNITS: t1�� ? NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: �QI SEPTIC TANK TYPE/MFG C �- / �a yL Q CAPACITY �� gal # OF COMPARTMENTS f 120 11.•...1111• GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT I] SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT I 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED U $owl. TITLE Contractor DATE 4/8/2022 t� O O �r 0 DEPARTMENJ USE ONLY Application Accepted B GL Date Area Employee ID#_�� tT Final Inspection By O `/� _/�1 7- Date zti ❑ SPECIAL PERMIT - Approved by Wt, V Character of Soil to Depth of 3 Ft: I PiVSump Soil Character: At COMMENTS PCIO&,AM41 Sf ch gel Non - / eDa. I r T,'a,i 1T , SO Y01os I PE SC Received Check#/ Amount ate Permit/ Invoice# PermitID# Code rd LEACH LINES LEACHING CHAMBERS #OFLINES�� ai$ LENGTH OF LINES 91 it s8 DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it ❑ FILTER BED WIDTH _ ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTA ft DEPTH ft � SUMPS n/C DISTANCET NEAREST WIDTH WELL ft It LEN GT FOUNDATION ft PROP TYLINE It DEPT _ It It DISTANCE TO NEAREST WELLit FOUNDATION ft PROPERTY LINE _ It ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft SEEPAGE PITS NUMBER WIDTH �3 , ft DEPTH as, ft DISTANCE TO NEAREST WELL��t }t FOUNDATION It PROPERTY LINE It I HEREBY CERTIFY THAT I 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED U $owl. TITLE Contractor DATE 4/8/2022 t� O O �r 0 DEPARTMENJ USE ONLY Application Accepted B GL Date Area Employee ID#_�� tT Final Inspection By O `/� _/�1 7- Date zti ❑ SPECIAL PERMIT - Approved by Wt, V Character of Soil to Depth of 3 Ft: I PiVSump Soil Character: At COMMENTS PCIO&,AM41 Sf ch gel Non - / eDa. I r T,'a,i 1T , SO Y01os I PE SC Received Check#/ Amount ate Permit/ Invoice# PermitID# Code INFO sh Remitted Servic Re uest # ai$ �s► s8 f iZUWA u, 008 515 *T AU }Hnk, Axlew*01�� r/ 17 14? - Added one Gly leach 11110 s � "r$` �C%" C- MYV 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT P 1 fS 1 1061+), t, . 5V ! 1899 /s