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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos AOORESS-s­LAmmER5-R9' 07s,80 S• 1� CITYIZIP TRACY 95377 <br /> � CROSS STREET <br /> S.OF VALPICO RD. APN 240-140-50 PARCEL SIZE 21.07 <br /> OWNER NAME LS-TRACY LLC PHONE 545-1185-SEAN <br /> OWNER ADDRESS 3130 CROW CANYON PLACE,STE.325 CITYISTATEMP SAN RAMON,CA 94583 <br /> CONTRACTOR HENNINGS BROS.DRILLING CO.,INC. PHONE 545-1165 <br /> CONTRACTOR ADDRESS 1930 LADD RD. CITYISTATEILP MODESTO.CA 95356 <br /> LICENSE 0CC-42 0CC-36 OTHER C-57 NUMBER 290813 EXPIRATION DATE 5-31-22 <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 IALTEIR'NATNE <br /> C REPLACEMENT L OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION %XXX 1GI11 <br /> INSTALLATION WILL SERVE: C RESIDENCE G COMMERCIAL n 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 981 #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C3LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES L. LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH it LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ DISPOSALPONDS WIDTH it LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY LINE IS <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 /> UM 48 HgUR ADVANC REQUI FOR INSPECIJONS-PLEASE CALL(209)953-769 <br /> SIGNE <br /> b E V DATE 12-1420 <br /> S E E A T T A C H E D IN <br /> DEPARTMENT USE ONLY AS <br /> Accepted By ��LLQ Date- R Z dOX Area /act Employee ID# <br /> Final Inspection By Date Ll SPECIAL MIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ",-POI Or seOAe 0hkr),' r7. To be )b ,nspejar <br /> PE Sc Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> a I 075" <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />