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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE • STOCKTON CA 95205 - (209) 468-3420 NON- REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS 7151 E. Peltier Road Crrv21P Acampo 95220 CROSS STREET Kennelick Road qpN 0 0 5-26 0 61 PARCEL SIZE 4 .4 0 0 OWNER NAME Holdener, Timothy R. & Lani PHONE (209) 603A000 OWNER ADDRESS 7151 E. Peltier Road CITY/STATE/ZIP Acampo, CA 95220 CONTRACTOR Dillon & Murphy PHONE (209) 334-6613 CONTRACTOR ADDRESS 847 N. Cluff Ave. CITY/STATE/ZIP Lodi, CA 95241 LICENSE U C42 J . 0-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y G PERC TEST # ' BUILDING PERMIT # LAND USE APPLICATION # 1800304 TYPE OF WORK: i ! NEW INSTALLATION ri REPAIRIADDITION 1 ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT is OUT-OFSERVICE SEPTIC SYSTEM ._. DESTRUCTION INSTALLATION WILL SERVE: L RESIDENCE L COMMERCIAL L OTHER NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OFLINEs LENGTHOFLINES It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ` ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft A DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft C�p, ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH ft LENGTH ft DEPTH ` � 4 DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE • • ft /09 L3 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 4 / —1 " V 40 DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE HF,, , _ Ty QN�NCp�N L] SEEPAGE PITS NUMBER WIDTH It DEPTH S FpgRNri il DISTANCE TO NEAREST VELLft FOUNDATION ft PROPERTY LINE ft MF�r I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, C' Y STATE LAWS AND RUFFS AND REGULATIONS OF SAN JOAQUIN COUNTY, MINIMUM48HQIIR ADVANCE NOTICE RE UIRED FOR INSPECTIONS - PLEASECALL (209) -7 7 SIGNED / TITLE I (' F DATE 1V / Z 1J 0cl IIIIL 11111 . 1111 11111 1111 HII * S E z h ? i AIC H t4 E N T DEPARTMENT USE ONL Y Application Accepted B Date Area /[� 1 y Employee ID#� Final Inspection By ate / C SPIAL PERMIT • Approved by Character of Soil tp�Depth of 11 FL PiUSump Sff Ilch . COMMENTS tt l, O/A r' o !i1^ /AL , PE SC Receivedr _ Che Amount Permit/ Invoice # Permit ID# Code INFO B Cash Remitted D�te Service Re uest # Z13, � 42-01 ONSITE WASTEWATER TRTt.1NT SYSTEM PERMIT 4/14118