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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPEC77ONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREss 27420 Walnut Court CITYILP Tracy,CA,95304 m <br /> CROSS STREET Hillview Sl. APN 248-240-21 PARCEL SIZE�T p <br /> 0 <br /> OWNER NAME Dennis M.Souza PHONE(209)-969-5754 <br /> OWNER ADDRESS 27420 Walnut Court CITYISTATEMp Tracy,CA,95304 <br /> CONTRACTOR Terracon PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 Industrial Way CITYISTATEI7JP Lodi,CA,95240 <br /> LICENSE ,jC-421' C-36 OTHER C-57 NUMBER 669004 EKPIRATION DATE 5-31-2021 <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST A 2 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION i ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ' DESTRUCTION <br /> INSTALLATION WILL SERVE: I 1 RESIDENCE 0 COMMERCIAL U OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH it <br /> DISTANCE To NEAREST WELL R FOUNDATION R PROPERTY LINE it <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ( 1 <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> -�jNCE NO 77CE REQUIR LL 1209)953-702I <br /> SIGNED ' L� TITL - ` DATE <br /> kr I <br /> IR <br /> AC lit r-C ll <br /> R t4E <br /> 1 <br /> EPA T NLY <br /> Application Accepted By Dat Area Employee ID# " <br /> 01 If <br /> Final Inspection By Date 0 SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIVSump Soil Character: <br /> COMMENTS <br /> PE SC Received hoc Amount Date Permit/ Invoice Permit ID# <br /> Code INFO B e Remitted Service Rs et 6 <br /> yy 3 5 X617 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114113 <br />