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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 L;HLL <br />JOB ADDRESS 19971 S AIRPORT WAY <br />CROSS STREET ATHERTON <br />OWNER NAME VALLEY INVESTMENT GROUP, INC <br />OWNER ADDRESS 760 RANDALL WAY <br />CONTRACTOR Modesto Sand and Gravel, Inc. <br />CONTRACTOR ADDRESS 6137 Hammett Ct <br />LICENSE 1 C-42 L_' C-36 OTHER C-12 C-21 <br />YDJ-/b5/ FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUEI <br />CITY/ZIP MANTECA 95336 <br />APN ��� " PARCEL SIZE / <br />PHONE 209-679-1920 <br />CITY/STATE/ZIP MANTECA, CA 95336 <br />PHONE 209-545-4425 <br />CITY/STATE/ZIP Modesto, Ca 95358 <br />NUMBER 271166 EXPIRATION DATE 02/28/2023 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION l ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT 17 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />LEACHING CHAMBERS <br />I I C RC <br />/ITCLJ /-VR /IV <br />TITLE <br /># OF LINES <br />- -/ V.7I <br />1yJ <br />l l� 2-1 Z 2— <br />LENGTH OF LINES <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <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 />IIIIIr1;irl <br />SIGNED <br />/YI 'F "wyn <br />' j �z <br />MU VMIV VC JVw <br />< � .l 1) C �—� <br />I I C RC <br />/ITCLJ /-VR /IV <br />TITLE <br />C 11%JIV - rLCMJC I -ML -L- LVy <br />Project Manager DATE <br />- -/ V.7I <br />1yJ <br />l l� 2-1 Z 2— <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />