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I. ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 t1YUN-ML-FUNUABLL h"ERMIT JOE ADDRESS 22092 S. SEXTON ROAD CROSS STREET RIVER ROAD OWNER NAME K. DARPINIAN e, SONS OWNER ADDRESS 5913 COFFEE ROAD CONTRACTOR Modesto Sand and Gravel, Inc. CONTRACTOR ADDRESS 6137 Hammett Ct YbJ-IW)I FOR INSPECTIONS EXPIRES 9 YEAR FROM UATE ISSUE CITY/ZIP ESCALON 95320 APN V C 7 q () `-' 1 PARCEL SIZE LICENSE ELIC -42 ]1r_IC-36 OTHER C-12 C-21 NUMBER 271166 PHONE 209-524-4442 CITY/STATE/ZIP MODESTO, CA 95357 PHONE 209-545-4425 CITY/STATE/ZIP Modesto, Ca 95358 EXPIRATION DATE 02/28/2023 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST fF BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Q SEPTIC TANK ® GREASE TRAP U LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ® PKG TX PLANT 7 gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ® SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES 1 1 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft EB SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE 70 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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) 9.5`13-7697 SIGNED ;� { Y r' �L `�s� TITLE Project Manager DATE T Application Accepted By Final Inspection By i Character of Soil to Depth of 3 Ft: COMMENTS nC PARTMEN,T Date Date JSE NLY l� L -6—Area 1 Employee ID# 71\ 67 ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: : _ --v b � C 'I"t0 , PE Code SC INFO Received 97 z2 Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# lt �1 5 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18