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1 <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 HERMIT <br />JOB ADDRESS 4950 Woodward Ave <br />CROSS STREET Airport Way <br />GALL (211.9) Yb3-10YI FOR INSPECTIONS EXPIRES I YEAR <br />CtTY/ZIP Manteca / 95337 <br />226-1709-030 <br />PARCEL SIZE 1.00 Acre <br />OWNER NAME Judy 8 Jerry Wackerly PHONE (209)969-8681 <br />OWNER ADDRESS 4950 Woodward Ave CITY/STATE/ZIP Manteca / CA / 95337 <br />CONTRACTOR J&M, Inc. <br />CONTRACTOR ADDRESS 6700 National Drive <br />LICENSE 11JC-42 0-C-36 OTHERA NUMBER 176709 <br />PHONE(925)724-0300 <br />CITY/STATE/ZIP Livermore / CA / 94550 <br />EXPIRATION DATE 09/30/2023 <br />WATER TABLE DEPTH: 8'7 it GEOGRAPHICAL INFORMATION: Coordinates X 37°46'31.1"N y 121 °14'53.8"W <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />II REPLACEMENT F OUT -OF -SERVICE SEPTIC SYSTEM R DESTRUCTION Septic Tank <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL it FOUNDATION it PROPERTY LINE it <br />❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />I LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />It PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />it <br />DEPTH ft <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />It LENGTH <br />it <br />DEPTH If <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />If <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />it PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />It LENGTH <br />it <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH it <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE it <br />I HEREBY CERTIFY THAT 1 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 FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED Manuel Marques TITLE Estimator DATE 11/11/21 <br />DEPARTMENT USEjONLY <br />Application Accepte y ��— Date /d d Area Employee INA G <br />Final Inspection By Date C1SPECIAL PERMIT - Approved by <br />Character of Soil to Depth o 3 Pit/Sump Soil Character: <br />COMMENTS Irb,r LPAf 1V1 LOT b3 fA IR,4 iA-tJ MY , _'j" q tnF t4b!' I X11' <br />O C, <br />� 0-000a <br />5 f-pTt(--rwr) <br />42-01 <br />4/14118 ( I l 2-3l /11 /12,�6SZ�AJASTEWATER TRTMNT SYSTEM PERMIT <br />