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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-REFUNDABLE PERMIT" CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 23225 Buena Vista Rd. CrY/ZIP CICIMEMS <br />CK055 5TREET Hwy 80 021210-5 <br />APN PARCEL SIZE 7.53 <br />OWNER NAME John Gaukel <br />PHONE <br />OWNER ADDRESS <br />.. _.. CITY/STATE/ZIP <br />CONTRACTOR west Coast Bao<hoc, Inc. PHONE 209-339-7394 <br />CONTRACTOR ADDRFSG 3? Maxwell St CFTYISTATE/ZJP Lodi, CA 55240 <br />LICENSE C42 C-36 OTHER A NIIMRFR 851157 EXPIRATION DATE 03/2023 <br />WATER TAB' -E DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # t/ JI O - 3 L) O LAND USE APPLICATION # <br />TYPE OF WORK: Vd NEW INSTALLATION REPAIRIADDmoN ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM nESTRUCTION <br />INSTALLATION WILL SERVE! W* RESIDENCE COMMERCIAL OTHER <br />NUMEER OF LIVING UNITS: NUMBER OF BIFUKUUMS: i NUMBER OF EMPLOYEES' <br />jam --SEPTIC TANK TYPE/IV1=G P8 L _ CA?ACITY 1200 gal i# OF COMPART'JEtfTS <br />❑ GREASETRAP TYPE/MFG CAPACITYgal #OFCOMPARTMEUIS <br />DISTANCE TO NEARES r: WLLL It FOUNDATION ft PROPERTY LINC <br />ft <br />❑ LIFT STATION SIZE TYPE OF PJMP ,7 PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />(d LEACH LINES LEACHING CHAMDCRS Infiltrators Aur LINES 2 LENGTH OF LINES 57' <br />fl <br />DISTANCE TO NEAREST WELL 150• ft FOJNDATION 20+ ft PROPERTYLNE 5+ <br />fl <br />U FILTER BED WIDTH It LENGTH It DEPTH <br />ft <br />DISTANCE TO NEAREST WELL _ _ ft FOJNDAT.ON ft FROPERTYLINE <br />ft <br />❑ MOUNDED WIDTH ft I FNr,TH ft DEPTH <br />fl! <br />DISTANCE TO NEAREST WELL It FOJNUATON it FROPERT Y LINE <br />ft <br />Cl SUMPS WIDTH ft LENGTH ft DEPTH <br />It <br />DISTANCE TO NEAREST WF.LI. h FOUNDATION It FROPEP,TYI WE <br />It <br />❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH <br />ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PRO-EP.TYUNE <br />ft <br />_SEEPAGE PITS NUMBER 2 WIDTH 3.5 _ ft DEPTH 25 <br />It <br />DISTANCE TO NEAREST WELL 150+ ft FOUNDATION 10+ ft PRO-ERTYLIN6 5+ <br />fl <br />S.�•.._.,._._...__..�-.-.,....TH .CRIK__�_-._SAN J ES. <br />I I!-REBY CERTIFY THAT I HAVE PREPARED <br />- THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUN COUNTY ORDINANCES. <br />ATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br />IIVIMUM48 HO DVANCE NOT19R UIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />TITLE Admin DATE 99'2022 <br />DEPARTMEN TJJSE NLY <br />'LA/ <br />�K <br />Application Accepted By//� Date i Area Employae IDT r <br />Final Inspertinn By Date SPECIAL PERMIT - Approoed by <br />Character n` Soll to Depth of 3 Ft: Pit/Sump Boll <br />l.Character; <br />COMMENTS <br />COMM[NTS �h( CG4f�,cC <br />►.J'P. 7G <br />L, <br />.2-C1 ONBITF WASTEWATER TRTMNT SYSTEM PERMIT <br /><n4it6 <br />