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I 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 209 953-7,697fOR INS IONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ✓ JOB ADDRESS 22006 S.Hwy 99 Q ZZ m/LP Ripon 95366 � <br /> M <br /> CROSS STREET Santos Ave APN 2281At PARCEL SIZE 4.5 Acres <br /> b <br /> OWNER NAME Craig DeJong PHONE 209-456-1427 <br /> OWNER ADDRESS 22000 S Hwy 99 CITYISTATEMP Ripon,Ca 95366 <br /> CONTRACTOR Modesto Sand and Gravel,Inc. PHONE 209-545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett CL Cm/STATEJLP Modesto,Ca,95358 <br /> LICENSE [1 C42 C-36 OTHER C-21 NUMBER 271166 EXPIRATION DATE Feb 2019 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ 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 H <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 It <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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TD NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> I 46 HQUA ADVANCEE REQUIREDFOR INSPECTIONS-PLEASE CALL2 7 <br /> SIGNED - _'r— TITLE Project Manager DATE 10/01/2018 <br /> AYM <br /> 491 <br /> A. <br /> CF�V��° <br /> FO <br /> IQ ?018 <br /> SNC <br /> gRHHry <br /> MFNT <br /> Dir RTME T E N Y <br /> Application Accepted By a Area Employee ID# <br /> Final Inspection By Date iq ❑ SPECIAL PE MIT-Approved by <br /> Character of Soil tt�iDepth of 3 Ft: PI Sump Soil Character <br /> COMMENTS li <br /> 12-111 <br /> (11 1 !VA %. ' 1 0 r <br /> PEI SC Received Check#/ Amount Date Permltt Invoice# Permit ID# <br /> Code INFO 8 ash emitted Service Request# <br /> 2 0 VI-1 <br /> 42-01 / 9 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />