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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 16475 S Tide Road CITY2IP Ripon,95386 a <br /> In <br /> CRn S STREET E French Camp Road APN 203-100-17 PARCEL SIZE 0.84 c <br /> OWNER NAME Jennifer E Chad De Jong ( � `�_G PHONE 209-968-8384 <br /> OWNERADDRESS POBOX131 Lrl QL7 � �( �. CITY/STATE/ZIP Ripon,CA 95386 <br /> CONTRACTOR PETRALOGIX ENGINEERING,INC. PHONE 209-770.0731 <br /> CONTRACTOR ADDRESS 26675 Bruella Road CITY/STATE/7JP Galt,CA 95632 <br /> LICENSE DOC-42 ❑DC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: -SSm eo hel Eelow p,wrtl aunao ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 PERC TEST #I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: D NEW INSTALLATION D REPAIWADDITION D ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM D DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE U 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 Cl PKGTXPLANT [3SAND OIL SEPARATOR(ENCLOSED SYSTEM) ft AMew <br /> LI LEACH LINES Il LEACHING CHAMBERS #OF LINES LENGTH OF LINES Ve1D <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE n <br /> L3 FILTER BED WIDTH ft LENGTH ft DEPTH r U 2019 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE_ fir <br /> [3 MOUNDED WIDTH ft LENGTH ft DEPTH Frfl Qu/IV Dov <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE HEAP f ONMENTAN7y <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It L) AL <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft 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 /> I STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> aAIArrMUM 48 HOUR_ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �?'� T o C//9hC <br /> 1 -YL, � <br /> 111 MINOR!! I <br /> _� ,.(�.y(Q/� TITLE�'���I/7rr?5�' DATE <br /> wit ��wq :... .:.. .::.: . . .L. <br /> l. <br /> ».R16�i�ti'o`��ele �.uv1> ,_-�•T:. . <br /> d 3 f4 <br /> w eS.'..0 •..e..1ernF�fe. <br /> i <br /> I _ :. <br /> To I&, L � <br /> .Y �i. t� { at � t "�',X i r .� �` i�,Ii• <br /> FT <br /> I I L I .. <br /> D` PART ENT SE Y <br /> Application Accepted By Date Area Employee ID# � <br /> Final Inspection By Date D SP AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount PermiU <br /> Code INFO B ash emitted Date Service Re nest# Invoice# PermitlD# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 (LIC"JJJS7�L7irf- ( (0 Q J `Z <br />