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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 /> JDs ADDRESS 11265 N.THORNTON ROAD CIrY/ZIp STOCKTON,CA 95209 <br /> CROSSSTREET EIGHT MILE ROAD ApN 055-200-03 PARCEL SIZE 4.60 b <br /> OWNER NAME FHRABUDDHIVONGSAMUNEE BUDDHIST TEMPLE ATTN MARIA COURAGEE PHONE 209-423-9356 <br /> OWNER ADDRESS 11253N,THORNTON ROAD CITY/STATE/ZIP STOCKTON,CA 95209 <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/ZJP LODI CA 95240 <br /> LICENSE C-42 -- C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION - ENGINEER D SIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH_ it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH _ ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it 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 WELLft FOUNDATION ft PROPERTY LINE _ it <br /> ❑ SEEPAGE PITS NUMBER WIDTH _ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 8 HOUR ADVANCE NOLKE REQUIRED FOR INSPECTIONS-pLEASE CALL(209)953-7697 <br /> SIGNED G(i)r(QiZG�- ./��17i TITLE STAFF SCIENTIST DATE 04/30/2019 <br /> F /N <br /> M i 1AT <br /> N <br /> DEPARTMENT E NLY <br /> Application Accepted By�-- Date Area Employee ID# <br /> Final Inspectlon By Date ] SPE AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#! Amount Date Permit/ <br /> rvice Request# Invoice Permit IDS <br /> Cade INFO B Cash Remitted Se <br /> 1' -- S Cl 7 <br /> IV <br /> 4201 <br /> M41?18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> d'I A <br />