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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 32851 S CHRISMAN ROAD CIN/ZIP TRACY CA <br /> CROSS STREET DURHAM FERRY ROAD OR VERNALIS/HWY 132 APN 253-190-10 PARCEL SIZE 1,10 > <br /> 0 <br /> OWNER NAME ANTHONY J AND BETRICIA 15ICKENS PHONE 209 814-1431 JOHN PICKENS <br /> OWNER ADDRESS 32851 S CHRISMAN ROAD CITY/STATE/ZIP TRACY CA 95304 <br /> CONTRACTOR TERRACON CONSULTANTS(NEIL O.ANDERSON 8 ASSOCIATES) PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI,CA 95240 <br /> LICENSE ❑CC42 ill-C-36 (OTHER C-S7 NUMBER 669004 EXPIRATION DATE 59 <br /> /31/1 <br /> WATER TABLE DEPTH: 'V .I'� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> IX PERC TEST # ' BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: - NEW INSTALLATION F REPAIRIADDIT1oN fl ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 'I 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 M PROPERTY LINE -_ft <br /> LILIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES_ ry <br /> DISTANCE TO NEAREST WELL It FOUNDATIONIt PROPERTY LINE _ (I <br /> ❑ FILTER BED WIDTH h LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ry <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH _ ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL R 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL (209)953-7697 <br /> SIGNEDoaw, �w_,w..r.,�.,, TITLE STAFF SCIENTIST PATE 8-2-18 <br /> Woods,Tamara <br /> f ..ti. <br /> 77 <br /> I»,3", ., <br /> 1f`LI• mice* <br /> ..r'��ir L C <br /> D N Ai <br /> r.=„ T <br /> D PAR MENT US+# <br /> ONLY ` 7 <br /> Application Accepted By /�Dale $�• ')Y Area J /�!r/ Employee ID# /'I h Mei <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIt1Sump Soil Character: <br /> COMMENTS <br /> PE SC Received 6hei;Mr Amount Date Permit/ <br /> Code PermItlDAt <br /> Code INFO B Cash Remitted Service Re uest# <br /> 42,11 )s 2 <br /> 42-01 <br /> 4/14118 ONSTTE WASTEWATER TRTMNT SYSTEM PERMIT <br />