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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 466-3420 NON-KEFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSL J013 ADDRESS 17400 West Bethany Road CrrY21P Tracy, 95391 CROSS STREET Byron Hwy. APN 209-150-29 PARCEL Sin3.0 Acres OWNER NAME Pinnacle Ridge LLC PHONE (925) 605-6762 OWNER ADDRESS 21315 San Jose Road CITY/STATE/ZIP Tracy, CA 95304 CONTRACTOR Gamey Pacific, Inc PHONE (925) 315-4201 CONTRACTOR ADDRESS 324 East 11th Street CITYISTATE/LP Tracy, CA 95376 LICENSE .. C-42 _. C-36 OTHER Class A _ NUMBER 999415 EXPIRATION DATE WATER TABLE DEPTH: 10.5 Feet Deep It GEOGRAPHICAL INFORMATION: Coordinates X Y _ PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADoiT10N ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM F X DESTRUCTION SysbmAbandonmonl S{' I INSTALLATION WILL SERVE: _ RE91DENCE _. COMMERCIAL _ OTHER N LENGTH NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: DISTANCE TO NEAREST ❑ SEPTIC TANK TYPEIMFG Unknown Existing Tank CAPACITY Unknown gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY UNE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE it ❑ FILTER BED WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH N LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELT It FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft I HEREBY CERTIFY THAT 1 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. Final Inspection By � Data I ZI -Z -1 _. SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: ` Pit/Sump Soil Character: COMMENTS r,0i711 t`(. 410; f'4 [+4'►j I/C Code INFO ( I„By_ Coq, I Remitted I )Dasa Service Request # Invoice # Permit ID# Ii d11 1 o7�' s is rT�1�L CC.tT 71 - zr az-D1 1 7 U L v— `p 2/51 2..t,Z 2— 4114/18 PAYMENT ZECEIVED J N 3 0 2022 1N JOAQUIN COUNTY, ENVIRONMENTAL 6ALTH DEPARTMENT ONSITE WASTEWATER TRTMNT SYSTEM PERMIT