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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-KEFUNDABLE PERMIT (:ALL (LUS) 1104-1091 FOR INSPECTIONS tXPIRES I YEAR FROM DATE ISSUE <br />JOB ADDRESS 16375 E. MILGEO ROAD CITY/ZIP RIPON, 95366 <br />CROSS STREET MURPHY ROAD <br />OWNER NAME JOANN SHIPHERD <br />APN 261-220-11 PARCEL SIZE 1.04 <br />925-935-9441 <br />OWNER ADDRESS 168 HILLTOP CRESCENT CITY/STATE/ZIP WALNUT CREEK, CA 94597 <br />CONTRACTOR TERRACON CONSULTANTS INC / AARON MEJORADO PHONE 209-367-3701 <br />CONTRACTOR ADDRESS 902 INDUSTRIAL WAY <br />CITYISTATE/ZIP LODI, CA 95240 <br />LICENSE ❑LIC -42 ❑❑C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06-30-2022 <br />D <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # 2 <br />1 BUILDING PERMIT# <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />❑ NEW INSTALLATION ❑ <br />REPAIR/ADDITION <br />7 ENGINEER DESIGNED /ALTERNATIVE <br />ft <br />REPLACEMENT n <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING 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 # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE fl <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES I I LEACHING CHAMBERS <br />#OF LINES <br />LENGTH OF LINES fl <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />It PROPERTY LINE fl <br />❑ <br />FILTER BED WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE fl <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST. WELL <br />It FOUNDATION <br />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 />STATE LAWS AND RULES AND REGULATIONS <br />OF SAN JOAQUIN COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE <br />CALL (209) 953-7697 <br />,..�.._.. <br />«« RTAFF RCIFNTIRT <br />..,.r, n7-91amn <br />l Vt PAHIMtNI US VNLY <br />Application Accepted By. D % d D4ZU Area Employee ID#� C� <br />Final Inspection By Date ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: <br />COMMENTS IIA tI I,— cl. r46 -k—' C 4 f� - rT �' DPi�ln-�P.0-iF ' y1 a It. bee -a- 10 <br />PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# <br />Code INFO 51 Cash Remitted Service Request # <br />aaa Sa3;3v� Z <br />42-01 /n• '�Jl-7 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 12- <br />9 <br />4CMIEWr <br />El vto <br />14 ?010 <br />�U/N co <br />Pg)N41RTuNrMENTY <br />