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'r <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REIFUNDABLE PERMIT CALL(209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 10922 E Jahant Road CITY/ZIP Acampo,95220 <br /> �,p <br /> CROSS STREET S,O j ` APN 007-380-28 PARCEL SIZE 4.99 0 <br /> ��-)"��- � O <br /> OWNER NAME .Xll 1.,J�n 1 1 �cw1 o { PHONE �I n <br /> OWNER ADDRESS R 0Oq v, J f• CITY/STATE/ZIP <br /> CONTRACTOR Petralogix Engineering, Incorporated PHONE 209-770-0731 (Cell) <br /> CONTRACTOR ADDRESS 26675 Bruella Road CITY/STATE/ZIP Galt, CA 95362 <br /> LICENSE ❑DC-42 ❑CIC-36 OTHER PG NUMBER 8657 PG EXPIRATION DATE N/A <br /> WATER TABLE DEPTH: +100 feet ft GEOGRAPHICAL INFORMATION: Coordinates X -121.183894 Y 38.201917 <br /> IX PERC TEST # 1 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I_ RESIDENCE ❑ COMMERCIAL I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <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 /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Project Geologist DATE - I,� <br /> *HE C E <br /> LZA <br /> FN <br /> Vj /N <br /> h T <br /> MN <br /> DE TMEN-TAJS,,E ONLY <br /> Application Accepted BV _ Date /Z 1-1 Area Employee ID# <br /> i <br /> Final Inspection By Date .' .j 4/;• SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth o 3 F : L r Pit/Sump Soil Character: f' <br /> COMMENTST%�iIir� 8� Z- �c5 �/Irl1A,��1.�. <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> Z Z3 /_ 7 �Z .177 <br /> 42-01 �� ✓ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />