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JOB ADDRESS 11265 N. THORNTON ROAD cird-zip STOCKTON, CA 95209 <br />CROSS STREET EIGHT MILE ROAD ApN 055-200-03 PARCEL SIZE 460 <br />OWNER NAME PHRABUDDHIVONGSAMUNEE BUDDHIST TEMPLE ATTN: MARIA COURAGEE PHONE 209-423-9356 <br /> <br />OWNER ADDRESS 11253 N THORNTON ROAD <br />CONTRACTOR TERRACON CONSULTANTS INC <br /> <br />CITY/STATE/ZIP STOCKTON, CA 95209 <br /> <br />PHONE 209-367-3701 <br /> <br />CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI CA 95240 <br />LICENSE -2 C-42 Di C-36 OTHER C-57 NUMBER 669004 EXPIRAPON DATE 6/31/19 <br />REPAIRADOMON <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER D SIGNED /ALTERNATIVE <br />DESTRUCTION <br />X PERC TEST 0 2 <br />TYPE OF WORK: NEW INSTALLAnoN <br />REPLACEMENT <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPEIMFG <br />DISTANCE TO NEAREST: WELL <br /> <br /> CAPACITY <br /> <br /> CAPACITY <br /> ft FOUNDATION <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZEL TON AVENUE- STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: D RESIDENCE <br /> <br />COMMERCIAL <br /> <br />OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal tit OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP Cl PKG TX PLANT Cl SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES LEACHING CHAMBERS 0 OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 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 OF SAN JOAQUIN COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOAREQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED t/c/n TITLE STAFF SCIENTIST DATE 04/30/2019 <br />11111M <br />DEPARTMENT <br />Date <br />Date <br />111111111 I I I I I I 1 <br />ApplicationApplication Accepted By 'tail' <br />Final Inspection By <br />11=11EMENIE111111111MINUNIMIN <br />1•11•111MINE1111111E111111111111MI 1.11=11•111111•1=1111111•1111•=1111 1111111..111-11111..111•11111.= 11111/4M111111111111=111111111=1111111E .v4 1111111111111111111111MMIII41511911111E '.1=11111•11111MICOMIACIA 11•1111M1111111111=111111161a41:111 IMMUININIUMIliGIZINIIIIIIN El INEMEIIIIIMMIELNIMMM/1111 <br />111111111111111M1MiiiiiiiMM11111 MIIMEI11111111111111111111M11111111011. 111•111111•1111111111111111011111111111111M INIIMME111111111111•111=111111EIM <br />SE/ONLY <br />Area Employee 105 <br />SPE AL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br /> PIUSump Soil Character: <br /> <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check* Amount <br />Cash Remitted Date Permit/ <br />Service Request 0 Invoice 0 Permit ID* <br />tA5 kt,2,3-g -1 2-2--*3%-t q;-//ci sfaonDscp7 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT