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d 4K a ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 IVUN-11sEFUNDABLE VERMIT L;ALL (EUY) SS:f-/tiJ/ FOR INSPECTIONS JOB ADDRESS 1 [)O(:) G o od'i (n CITY/ZIP Ripon 95366 CROSS STREET Dexter APN c? -1 o d)- g PARCEL SIZE ' EXPIRES 1 YEAR FROM DATE ISSUE OWNER NAME DASCO Greenwood, LLC OWNER ADDRESS 11171 -Street CONTRACTOR Modesto Sand and Gravel, Inc. CONTRACTOR ADDRESS 6137 Hammett Ct PHONE 866-526-4214 CITY/STATE/ZIP Modesto, Ca 95354 PHONE 209-545-4425 CITY/STATE/ZIP Modesto, Ca 95358 LICENSE 110C-42 ❑DC -36 OTHER C-12 C-21 NUMBER 271166 EXPIRATION DATE 02/28/2023 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION Ll REPAIR/ADDITION I 1 ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION Septic 1 ank INSTALLATION WILL SERVE: 1 RESIDENCE f I COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: E] SEPTIC TANK TYPE/MFG Received Check#/ Cash CAPACITY Permit/ Service Request # gal # OF COMPARTMENTS 0 GREASE TRAP TYPE/MFG o -7 S'1 CAPACITY S 2 gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT ® SAND OIL SEPARATOR (ENCLOSED SYSTEM) ® LEACH LINES 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 C SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 07 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 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. IVIINTRII/V1 IVVIa YM IV VC IVWI 1%,F- G V RLIJ 0-V 1IMJr-CL I IVIV.7 - I -LC J LL I&UV J -I PZ7I SIGNED 1-ZLCT1_ _ __-_ TITLE Project Manager DATE DEPARTMENT U E ONLY /� Application Accepted Date t a b � a Employee ID# Area f J21 �� A Final Inspection By Date 27i ❑ SPECIAL PERMIT -Approved pproved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS L6n rdptilr Tier -9 — A,ct*ess Yn,G, he+VC been laol Oe4aeh a� one po,n� / r _A)a p Cty„,}5 fvr S P},L or, i-ow�Ior1 iF �Gnl[ UhKriO►�YI c�� L F�P/rn�i ISSUPr.�. PE Code SC INFO Received Check#/ Cash Amount Date Remitted Permit/ Service Request # Invoice # Permit ID# gal o -7 S'1 S 2 41 4//1414/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT