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SR0083443
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083443
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Last modified
7/28/2021 2:52:41 PM
Creation date
7/28/2021 2:25:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083443
PE
4222
FACILITY_NAME
500 N JACK TONE RD
STREET_NUMBER
500
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
LINDEN
Zip
95215
APN
10504022
ENTERED_DATE
3/22/2021 12:00:00 AM
SITE_LOCATION
500 N JACK TONE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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T <br />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 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 500 North Jack Tone Road CITY/ZIP Linden, CA 95215 <br />CROSS STREET E Copperopolis Road j APN 105-040-22 PARCEL SIZE 64.31 Acres <br />OWNER NAME Henry Foppian0 'AM'kj L (-C PHONE ��.,, Q <br />OWNER ADDRESS 1Dfy,6O/� (r) -CITY/STATE/ZIP brK/r'1-) <br />CONTRACTOR Terracon Consultants/Aaron Mejorado PE TTT PHONE 209-367-3701 <br />CONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/ZIP Lodi/CA/95240 <br />LICENSE ❑-C-42 0:C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06/30/2022 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />]� PERC TEST # 3 <br />BUILDING PERMIT # <br />❑ FILTER BED WIDTH ft LENGTH <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION I_ <br />REPAIR/ADDITION <br />C ENGINEER DESIGNED /ALTERNATIVE <br />DISTANCE To NEAREST WELL <br />REPLACEMENT i <br />OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />C OTHER <br />NUMBER OF LIVING <br />UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal If OF COMPARTMENTS <br />FOR INSPECTIONS - PLEASE CALL 12091 953-7697 <br />DISTANCE To NEAREST: WELL <br />it FOUNDATION <br />ft PROPERTY LINE It <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES 7 LEACHING CHAMBERS <br />#OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTYLINE It <br />❑ FILTER BED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION ft PROPERTYLINE It <br />❑ MOUNDED WIDTH It LENGTH <br />It DEPTH ft <br />DISTANCE To NEAREST WELL <br />It FOUNDATION ft PROPERTYLINE ft <br />❑ SUMPS WIDTH ft LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH it LENGTH <br />ft DEPTH it <br />DISTANCE To NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE it <br />❑ SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH it <br />DISTANCE TO NEAREST WELL <br />It 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 <br />FOR INSPECTIONS - PLEASE CALL 12091 953-7697 <br />SIGNED TAMARA WOODS WondR Tamara $�"��'w. °,ate .K,T°��" TITLE STAFF SCIENTIST DATE 03-19-2021 <br />DEPARTMENT USE NLY <br />Application AcceptedB Date as .T Area 4�1 Employee ID#_M_� <br />Final Inspection By melyDate ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to ept�h Qf 3 Ft: PIUSump Soil Character: <br />COMMENTS " i K0'(ZJ Of flUC 'P—f0r11 'n bt tGti '"\ J e e- <br />PE Sc Received Check#/ Amount Date Permit] Invoice # Permit IDN <br />Code INFO BV Cash Remitted Service Request # <br />Naa a say ` s6 •22 <br />4 ( V ��K> >� U ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14//14/ 18 <br />
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