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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 ell <br />ll \ L <br />(;ALL (ZUY) YDJ-/DJ/ FOR INSPEGTIONS CXPIRE5 7 TEAR FROM DATE 155UEI <br />JOB ADDRESS I Vj,13 '-1I' l O'n Y 2, ^ CITY/ZIP CA!. % f, -)({;� <br />CROSS STREET 1/x.1 Sa.r t�o , —4 f42, APN 0 a ! ' V � �% � � � PARCEL SIZE <br />OWNER NAME l � U n s ic �I LJGI I e-3 /" `t r� e V1 PHONE <br />r^ 1 Wil; �S <br />OWNER ADDRESS aS � ✓Y'J �S � 1 CITY/STATE/ZIP <br />CONTRACTOR TERRACON CONSULTANTS INC. / AARON MEJORADO PHONE 209-367-3701 <br />CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI, CA 95240 <br />LICENSE C-42 C-36 OTHER PE NUMBER 72446 E) PIRATION DATE 06/30/2022 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />1� PERC TEST # 3 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: x RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />It FOUNDATION <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />It PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />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 <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />// DEPARTMENT,USE NLY <br />Application Accepted By �`// Date Z ZJ ;7 Area l VI Employ AID# w �O <br />Final Inspection By =� , CC �C��s>� Date %%/2Z�Zj SPECIAL PERMIT - Appr e <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS �_ A <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />