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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 />NON-KEFUNDABLE PERMIT GALL (LUN) V0J-/0H/ FOR INSPECTIONS tXPIRES 7 YEAR FROM DATE ISSUE <br />JOB ADDRESS 6253 Linne Rd CrrYIZIP Tracy/95304 <br />t1 <br />CROSS STREET Depot Master Dr. APN d 7 SD 130 4 I PARCEL SIZE d?' 3(a <br />OWNER NAME Keith Fredrickson PHONE <br />OWNER ADDRESS 16145' Fr eck► u, k s or CITY/STATE/ZIP Inc, derr. 8363 8 � <br />CONTRACTOR West Coast Backhoe, Inc. PHONE 209-339-7394 <br />CONTRACTOR ADDRESS 33 Maxwell St <br />CrrY/STATE/LP Lodi,CA 95240 <br />LICENSE C-42 L C-36 OTHER A NUMBER 851157 EXPIRATION DATE 9/30/2023 <br />D <br />WATER TABLE DEPTH: <br />PERC TEST # <br />TYPE OF WORK: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />BUILDING PERMIT #_aLD3 919 #_D3919LAND USE APPLICATION # <br />NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />rI COMMERCIAL <br />LI OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4 <br />NUMBER OF EMPLOYEES: <br />�,,/ <br />i0 SEPTIC TANK <br />TYPE/MFG P&L <br />CAPACITY 1600 <br />gal #OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 100 + fl FOUNDATION <br />it PROPERTY LINE <br />it <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />_EACH LINES <br />x LEACHING CHAMBERS Infiltrators <br /># OF LINES/ <br />LENGTH OF LINES ` a <br />ft <br />DISTANCE TO NEAREST WELL 100 <br />ft FOUNDATION 10+ <br />ft PROPERTY LINE 5+ <br />it <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />fl PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />it <br />DEPTH <br />ft <br />DISTANCE TTO NEAREST WELL <br />R FOUNDATION <br />ft PROPERTY UNE <br />it <br />91"SEEPAGE PITS <br />NuMsER!' W..f4 <br />ft DEPTyi-e <br />ft <br />DISTANCE TO NEAREST WELL 150 <br />ft FOUNDATION 10+ <br />ft PROPERTY LINE 5+ <br />it <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 />DEPARTMENT USE ONLY A5 <br />Application Accepted By L /G 1L /,—Date S Area J —1 1 Employee ID# <br />Final Inspection ByC'+cnj-!I1z /nc.=f.a �L'a. Data 1 SP CIALPERMIT-Approved by <br />Character of Soil to Depth of 3 Ft: PIVSump Soil Character. <br />COMMENTS)A �.t�l non-rcpr;. it (Arnenck �L! l+ . no p lis anS- Stith L..iL 1.,mPt A)— —sic •�.�r.....ra oi/ L,Ii 42&,,1��� (�/1P e-/Dy/77 <br />PE Sc Received Chec Amount Date Perm1U Invoice # Permit ID# <br />Code INFO B ash Remitted Service Re uest # <br />Oat t I� s>T 3 .�_ <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />