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it <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />111ON-KEFUNDABLE FERMI1 <br />JOB ADDRESS 980 Warren Road <br />CROSS STREET Deader <br />OWNER NAME DASCO Greenwood, LLC <br />OWNER ADDRESS 11171 -Street <br />CONTRACTOR Modesto Sand and Gravel, Inc. <br />CONTRACTOR ADDRESS 6137 Hammett Ct <br />LICENSE ❑1jC-42 ❑LIC -36 OTHER C-12 C-21 <br />V0,3-dbVd FOR INSPECTIONV5 CXP'IKtS "I T tAK I KUM UA It IJbUt <br />CITY/ZIP Ripon 95366 p <br />APN o?�� J � S C7 a PARCEL SIZE <br />0 <br />PHONE 866-526-4214 <br />CITYISTATE/ZIP Modesto, Ca 95354 <br />PHONE 209-545-4425 <br />CITYISTATE/ZIP Modesto, Ca 95358 <br />NUMBER 271166 EXPIRATION DATE 02/28/2023 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # buLDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: J NEW INSTALLATION I I REPAIRIADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />_1 REPLACEMENT Ll OUT -OF -SERVICE SEPTIC SYSTEM )( DESTRUCTION Septic Tank <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />• SEPTIC TANK <br />TYPE/MFG <br />Received <br />By <br />CAPACITY <br />Amount <br />Remitted <br />gal # OF COMPARTMENTS <br />Invoice # <br />• GREASE TRAP <br />TYPE/MFG <br />ass <br />CAPACITY <br />r'� 8 <br />gal # OF COMPARTMENTS <br />'M@9505 <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />® LIFT STATION <br />SIZE TYPE OF PUMP <br />® PKG TX PLANT <br />® <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Q LEACH LINES <br />C, LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />O FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />l MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />U SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft 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 />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />0 SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I <br />HAVE PREPARED THIS APPLICATION <br />AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />I' I' I' I' I' I' I' I' I' I' I' I I' I I I I I I I I I <br />DEPARTMEN USE ONLY / <br />i <br />Application Accepted � <br />�� LL Date s D 6 a Area i a� Employee ID# v <br />Final Inspection By Date/ f%�/l�f �1,o❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Nvn rep-mIr '1;9r- -11 — No SUp4Ic belyvll+S oy, rite- L-ocaht01 6r Mrik <br />OnkylDv4n ol-- h'Me DGrmii ;ssued, <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />as 1 <br />ass <br />r'� 8 <br />S�Mal <br />'M@9505 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />