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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 <br />RUN-KEFUNDABLE PERMIT GALL 2U'J `JJJ-/D'J/ FOR INSPECTIONS tXPIRES T TEAR FROM DATE ISSUEI <br />JOB ADDRESS 811 River Rd. Crry/ZIP Ripon <br />CROSS STREET warren / p APN 24534035 PARCEL SIZE <br />/� <br />OWNER NAME C1 ZY Q l`�t Pot,,' �J'1 PHONE <br />OWNER ADDRESS - I ,��j�j ✓MGA r' V ti CITY/STATE21P b� I qS3 Wo <br />CONTRACTOR Modesto Sand and Gravel, Inc. PHONE 545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct CITYISTATE/ZIP Modesto, Ca 95358 <br />LICENSE LJ C-42 '.J C-36 OTHER C-21 NUMBER 271166 EXPIRATION DATE Feb2019 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />I PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />DISTANCE TO NEAREST <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDmON <br />ENGINEER DESIGN /ALTERNATIVE <br />❑ FILTER BED <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />! <br />INSTALLATION WILL SERVE: L 1 RESIDENCE <br />COMMERCIAL <br />U OTHER <br />DISTANCE TO NEAREST <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft LENGTH <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST <br />DISTANCE TO NEAREST: WELL <br />it FOUNDATION <br />it PROPERTY LINE <br />ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />ft <br />DEPTH�� <br />A/^�� <br />(ANC - <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />L3 MOUNDED <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />E VE® <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH fillI <br />Q <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />J 2018 <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH SAN J(�, <br />E <br />' N COUNN <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />MENTAL <br />L]SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH STH <br />ARTMENT <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 />PE SC Received hec Amount Permit/ <br />Code INFO By_ sh emitted Date Service Request # Invoice # Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <br />