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- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E-HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 33503 5 Koster Road CTTy1ZIP Tracy,95304 <br /> CROSSSTREET Kenner Road APN 255-090-32 PAncrLSIZE 1.26 <br /> OWNER NAME Brent HonnoH PHONE (209)740-8387 r <br /> OWNER ADDRESS 33503 S Koster Road CITYISTATE/ZIP Tracy,CA 95304 <br /> CONTRACTOR Petralogix Engineering,Inc. PHONE (209)770-0731 <br /> CONTRACTOR ADDRESS 26675 Bruella Road CITYISTATEIZIP Galt,CA 95632 <br /> LICENSE ❑r1C-42 [1[[C-36 OTHER PG NUMBER 5657 EXPIRATION DATE 4/30/2023 <br /> anc�Krarner <br /> WATER TADLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdinateS X(a f" ti`% - 5A5 Y 3-7"3 8 38,X73 <br /> ® PERC TEST #__t- BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK; F NEW INSTALLATION ❑ REPAWADDITION L1 ENGINEER DESIGNFU IALTERNATNE <br /> I1 REPLACEMENT f 1 OUT-OFSERVICE SEPTIC SYSTEM R DESTRUCTION <br /> INSTALLATION WILL SERVE; EJ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYeES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMCNTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> 1 DISTANCE TO NEAREST: WELL ft FOUNOATTON R PROPERTY LINE ft <br /> Q LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION k PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> Q MOUNDED WIDTH It LENGTH ft DEPTH k <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH k DEPTH it <br /> DISTANCE TO NEAREST WELL k F0t1N0ATION ft PROPERTY LINE k <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TD NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION k 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNEDSIC TITLE Project GEOIOgist DATE 09/02/2021 <br /> ITT- <br /> 3 Z�21 <br /> 1 Co <br /> Nr UNn` <br /> DEPARTMENT USE ONLY �— e��;} TMENr <br /> Application Accepted By } ���� Date �' '{ o T Area / Employee ID# - <br /> Final Inspection By Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitfSump Soil Character: <br /> COMMENT5 <br /> PE SC Received Cheok#/ Amount a Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-0 <br /> df7d117 1 I .� `�I 1 q 1 CI i"Py 5 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> V 1 1 1 <br />