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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 GALL (ZI19)953-7691 FOR INSPECTIONS EXPIRES 1 YEAR FROM UATE ISSUEI <br />JOB ADDRESS j 0 SD Warren Road CITY/ZIP Ripon 95366 <br />CROSS STREET Dexter APN ,� S bl o� D Da PARCEL SIZE I l <br />OWNER NAME DASCO Greenwood, LLC PHONE 666-526-4214 <br />OWNER ADDRESS 11171 -Street CIN/STATE/ZIP Modesto, Ca 95354 <br />CONTRACTOR Modesto Sand and Gravel, Inc. PHONE 209-545-4425 <br />CONTRACTOR ADDRESS 6137 Hammett Ct <br />CITY/STATE/ZIP Modesto, Ca 95358 <br />LICENSE 11CC-42 ❑CC -36 OTHER C-12 C-21 NUMBER 271166 EXPIRATION DATE 02/26/2023 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION aepnc 1 anre <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT ❑ <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />PIS -6 <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ 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 />❑ 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 />❑ 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 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 />❑ 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 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 <br />NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED IVT& A--,,2 <br />til 111 is �%�- <br />TITLE Project Manager <br />DATE <br />Application Accepted B <br />Final Inspection By <br />� <br />Character of Soil to Depth of 3 Ft:_ <br />COMMENTS 1�nuSP_ •,JG, <br />L ueFRk i yiEiv-! UJ 0-A/I Y- %D <br />Date 7 c?6 Area �/ /� • PJ;h Employee ID# <br />Date ❑ SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />PE SC <br />Received <br />Amount <br />Permit/ <br />Code INFO <br />By cCas <br />Remitted <br />Date Service Request # Invoice # Permit ID# <br />d.1 1 0-7S_I <br />q <br />PIS -6 <br />?- 2 0-0-9—' 5_5 g <br />Q <br />42-01 17P1,00 <br />4!14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />15a.- In ot-- 4 ISI <br />