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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQVm COUNTY ENVIRONMEiTAL HEALO-I DEPARTMENT 1868 E.HAZEL70N AvENUE-STOCKTON CA 95205-(209)4683A20 <br /> NON•REFUNDAaLE PERurr CALL L20J9 953-7697 FDR IkSPECTIDIVS ExPIRE3 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4011 E.Woodson Rd. Crn'12w AcampO 95224 <br /> Crass STREET Leadstone Gr, ApN 00.5.160-31PARCEL Ste2.14 Acres <br /> , <br /> OWNER NAME Fablola Guvnan e <br /> PHONE( 1406-6498 �+ <br /> OWNER AoDAU35 4011 E Woodson Rd. C1tYlSYATF-)ZIP AcamPo,CA$5220 <br /> CaNTRAMR Uwe Oak GeoEnvlronmenrat PHONE [ )364-A375 <br /> CaNTRACTOR ADaRESS 407 W.Oak St CrryISTATF121P Lodi.CA 95240 <br /> LICENSE ❑OC-4x ❑OC36 OTNER CEG NumsER 2551 EIPIRAT*R DATE 4=24 <br /> WATER TABLP DEPTH: ft GEOGRAPHICAL tWORAU.TICN: Coordinates X Y <br /> 3, PFRC TEST 0 1 BUILDING PERMfT O LAND USE APPLICATION# <br /> TYPE OF WORK: kE11v INSTALLATION ❑ REPAIWAnomaN - ENoiNEER DsmowEO JALTERNAmw <br /> REPLACEMENT 0 OuTOP.SERvICE SEPDC SYSTEM F DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE D CaMMERCLIL 0 OTHER <br /> NuNBER OF W W6 UNITS: Nl]NBER OF BEDROCKS: NUMBER OF ENPLOYEEs: <br /> E3 SEPTICTAMC TYPEIMFG CAPACITY gal 9OFC0"PARTMEN7S <br /> ❑ GREASETIRAP TrPEIMFG CAPACITY gal #OFCOMPARTMENTS_- <br /> DrSTANCE Ta NEAREST: W 2LL ft FOONDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U PKK;TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES ❑ LEACHING CHAMBERS #OFUNEs LENGTHOFLLNEs R <br /> DISTANCE TO NEAREST WELL ft FOUNOAT10w ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DL5TAMCE TO NEAREST WELL ft FOLWOATION ft PROPERTY LINE ft <br /> ❑ MOUNDED W"m ft LENGTH it DFPTm It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPE9TYL1NE R <br /> ❑ SUMPS WVM ft LENGTH ft DEM14 4 <br /> DISTANCE TO NEAREST WELL_It FOUNDATION R PROPERTY LINE ft <br /> CI DISPOSALPONDS Worm ft LENGTH ft DEPTH ft <br /> DLSTANCE TO NEAREST WELL ft FOLINDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIOrH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY UNE A <br /> I HEREBY CE RTI FY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SMI JOAQUIN COUNTY OROWANCES. <br /> STATE LAWS AND RULES MMD REGU LATION5 OF SAN JOAQUIN COU NTY_ <br /> MINIM M 48VOUR ADVAN E NOTICE R !R 0 FOR IN PE N -PLEASE (2 09)953,7 697 <br /> SIGNED J l TITTj�Project M anager DATE <br /> rN <br /> DEPARTMEN $ orI Y ►+y. <br /> Application Accsptad Uy Data Area -f Employee IDN <br /> Final lnspectlon By Date ❑ SPEC PERM[T-Approved by <br /> Character of Solt to Depth of 3 FC PWSUMP Soll Char ct <br /> COMMENTS l6� <br /> Z-1*�0 ?(1] <br /> PE SC ReZa W Chao Amount ParmlN E4 R� <br /> Codi INFO B h ernleead Dam Servlp Uest9 Invoice;« Permit 100 <br /> �T <br /> VIV 18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4![41 <br />