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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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> 2505 S MacArthur Drive CITYIZIP Tracy/95376 <br /> 246-140-05 PARCEL SIZE 4500 sgft e <br /> CROSS STREET Valpico APN oW <br /> OWNER NAME City of Tracy <br /> PHONE 209 831-6457 9 <br /> 333 Civc Center Plaza CITY/STATE/ZIP Tracy/CA/95376 <br /> OWNER ADDRESS 1 �� �(���( � 7� <br /> 2 ��r' Y l Vl C�PHONE O 1-1-�-4 1 2 10 Z <br /> CONTRACTOR 1 (�f <br /> CONTRACTOR ADDRESS <br /> �G'� �ef\l CITY/STATEIZIP,5 'YY) <br /> �( � l � � - _ _ _ <br /> LICENSE F�-C-42 ❑.-C-36 OTHERGin'�' NUMBER �fJ `�L-i1'�EXPIRATION DATE \�,30! -vlC\ <br /> WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> REPAIRIADDITION _ ENGINEER DESIGNED(ALTERNATIVE <br /> TYPE OF WORK: - NEW INSTALLATION - eptic pits <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL O ER <br /> NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPElMFc <br /> CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION <br /> ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LI #QF LINES LENGTH OF LINES LEACH LINES I LEACHING CHAMBERS ft <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft LENGTH ft DEPTH ft <br /> ❑ FILTERBED WIDTH ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft DEPTH ft <br /> 13 MOUNDED WIDTH ft LENGTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft DEPTH ft <br /> ❑ SUMPS WIDTH ft LENGTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft DEPTH ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SEEPAGE PITS NUMBER Z WIDTH <br /> 10x6 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION It PROPERTY LINE 10 ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS <br /> LAWSAPPLICATION <br /> LICATI N NAND AND <br /> SAN DONE <br /> N ALCORAQUIN ANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STAT <br /> Y. <br /> CE REQUIRE LL.(202LBAI-IM <br /> TITLE DATE <br /> SIGNED <br /> MENT <br /> EIVED <br /> 2 6 2019 <br /> ONIME COUNTY A- <br /> DEPARTMENT <br /> EPARTMEN U E NLY <br /> Application Accepted <br /> Date Area Employee ID# <br /> Final Inspection By <br /> L Date ❑ SPE AL PERMI -Approved by <br /> Pit/5 p oil Character: <br /> Character of Soil to De th of 3 Ft: <br /> COMMENTS <br /> Permit/ <br /> APEASC Received Check#I Amount Date Service Re uest# Invoice# Permit I h Re itte <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 4114118 <br />