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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 26850 N.LOWER SACRAMENTO ROAD CITYILP ACAMPO,CA v_ <br /> LIBERTY ROAD r" <br /> CROSS STREET ApN 005-030-07 PARCEL SIZE 70.0 > <br /> 0 <br /> OWNER NAME VENTANA DEVELOPMENT CO.INC.C/O NORMAN HULBERG PHONE 408-279-1520 <br /> OWNER ADDRESS 55 MARKET STREET,SUITE 1210 CITYISTATE/ZIP SAN JOSE,CA 95113 <br /> CONTRACTOR TERRACON CONSULTANTS INC. PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/ZIP LODI CA 95240 <br /> LICENSE C-42 -1 C-36 OTHER C-57 NUMBER 710079 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y- <br /> Ix <br /> PERC TEST #10(zs ni BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM - DESTRUCTION <br /> INSTALLATION WILL SERVE: J RESIDENCE J COMMERCIAL 0 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELLft FOUNDATION it PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH w ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPT14 AIN 1 4 n ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH JJ JOAQUIN Col I ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY JWrAILTH nc ENTAL ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH � � ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT[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 /> MINIMUM48Hq <br /> SIGNED C 72 sZ/Zet ( (.(�(y p TITLE STAFF SCIENTIST DATE 06/1012019 <br /> LIBERTY ROAD <br /> r <br /> O <br /> X <br /> A <br /> e) <br /> D <br /> n <br /> M <br /> M <br /> 0 <br /> O <br /> D PARTMENT SE N Y X <br /> Application Accepted By Date Area G� Employee ID# <br /> Final Inspection By .'�:'i .4\ �(� .;Z.L^'- Date I F ❑ SPE AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/Sump'Soil Character: <br /> COMMENTS <br /> r- <br /> PE SC Received (Chet Amount Date Permitt Invoi ' # Permit ID# <br /> Code INFO B -Cash-- Remitted Service))Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4,'14,118 <br />