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r <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 PERMIT CALL(209 953-7697 FOR INSPECTIONS _ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 15999 W.Corral Hollow Road CITY/ZIP Tracy <br /> nyi <br /> CROSS STREET 580 Freeway APN 251-140-05 PARCEL SIZE 5753.40 ac b <br /> 0 <br /> OWNER NAME Department of Energy,Lawrence Livermore National Lab-CIO Ada Chan(Site Rep) PHONE(925)422-1100 <br /> OWNER ADDRESS 15999 W.Corral Hollow Road CrrYISTATE/ZIP Tracy <br /> CONTRACTOR Petralogix Engineering Incorporated PHONE(209)400-5729 <br /> CONTRACTOR ADDRESS 26675 Bmella Road,Galt,CA 95632 CITY/STATE/ZIP 95632 <br /> LICENSE - C-42 C-36 OTHER PG NUMBER°p51 Pp''me acP.reecec EXPIRATION DATE N/A <br /> WATER TABLE DEPTH: 100+ ft GEOGRAPHICAL INFORMATION: Coordinates X -121.537373` Y 37.667148' <br /> FERC TEST #I I I BUILDING PERMIT#NA LAND USE APPLICATION#NA <br /> TYPE OF WORK: NEW INSTALLATION I I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: _ RESIDENCE L 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP CI PKGTX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES r- LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE It 1 <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTHc�k <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It P <br /> ❑ MOUNDED WIDTH It LENGTH It DEPTH �6h <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH tS It 1?0,,9 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE p V✓ <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH �/T,/'f! �/�CQ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Q qR�T�NrY <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It Tit,FNr <br /> DISTANCE TO NEAREST WELL It 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-7WtEfi4kP REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N 1 R FOR INSPECTIONS-PLEASE ALL 2 -7 7 <br /> SIGN E —�t�tE-- // i: 0 7 <br /> P £ I ,< ',� DATE (= <br /> .1 <br /> /-Till' 11111 11111 1111 111 1111 <br /> C <br /> iiii III Hill III HL <br /> 44 -L <br /> DEPARTMENT USE ONLY rl LL <br /> c' C <br /> Application AccepteWepth4of3lFt: <br /> Date �: i Area J Employee ID# <br /> Final Inspection By Date ._ $PEC/ PERMIT-Approved by <br /> Character of Soil to PiU S�mI/p Soil Characfter: _ <br /> COMMENTS a II { a* ('G�(G4 ��i fh:r f>a'(rYl, vv,Ii Q 5��'1 <br /> v r Zv1� <br /> • Lim M/ <br /> 6_ <br /> PE SC Received ec Amount fate Permit/ ImroieeR Permit IDR <br /> Code INFO 8 asn I memitted Service Ruest# <br /> Z '2 1 2 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />