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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E.HAZELTON AVENUE-STOCKTON CA95205-(209)4683420 <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 y <br /> ni <br /> CROSS STREET 580 Freeway APN 251-140-M PARCEL SCZE 5753.40 ac c <br /> b <br /> OWNER NAME Lawrence Livermore National Lab-C/O Blake Brown(Site Rep) "_-_ PHONE(925)495-9657 <br /> OWNER ADDRESS 15999 W.Corral Hollow Road CITY/STATE/ZIP Tracy <br /> CONTRACTOR PetralogiX Engineering Incorporated PHONE(209)400-5729 <br /> CONTRACTOR ADDRESS 26675 Bruella Road,Galt,CA 95632 CITY/STATEIZIP 95632 <br /> LICENSE ❑-:C-Q i C36 OTHER PO NUMBER a�1G'0'a'GP"�«c EXPIRATION DATE N/A <br /> WATER TABLE DEPTH: 100+ f1 GEOGRAPHICAL INFORMATION: Coordinates X-121.537373° y 37.667148" <br /> PERC TEST #I BUILDING PERMIT#NA LAND USE APPLICATION#NA <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <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 /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE _ TYPE OF PUMP____ ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS _ #of LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It 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 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 RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ] / <br /> UM 48 HOUR ADV4NCE NOTICE REQUIRED FOR INSPECTIONS. CAL4 09) 3-7 <br /> SIGNED G _ _ TITLE / -> (OC DATE !_/�odJ <br /> ` PAY IV NT <br /> ED <br /> 2020 <br /> U N COUNTY <br /> IR MENTAL <br /> L TMENT <br /> DEPARTMENTUSE ONLY <br /> Application Accepted B L Date "? Area � <br /> Employee ID# �.Q <br /> Final Inspection By Date a SPECT PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: P' ump Soil Character: <br /> COM NTS ' lz: ( 6" � <br /> V <br /> co aoo a ,ti,"R/;h c <br /> PE Sc Received Check#/ Amount Permit/ <br /> Code INFO B Remitted Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />