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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -Sr-LAMMERS-RG/7 a 7c 80 s L-0 pi me cirazip TRACY 95377 CROSS STREET S. OF VALPICO RD. ApN 240-140-50 PARCEL SIZE 21'07 OWNER NAME LS-TRACY LLC PHONE 545-1185- SEAN OWNER ADDRESS 3130 CROW CANYON PLACE, STE. 325 CITY/STATE/ZIP SAN RAMON, CA 94583 CONTRACTOR HENNINGS BROS. DRILLING CO., INC. PHONE 545-1185 CONTRACTOR ADDRESS 1930 LADD RD. CITY/STATE/ZIP MODESTO, CA 95356 LICENSE El E.C-42 0 PC-36 OTHER C-57 NUMBER 290813 EXPIRATION DATE 5-31-22 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Li PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: L NEW INSTALLATION L REPLACEMENT L REPAIR/ADDITION L OUT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION XXXX J611k INSTALLATION WILL SERVE: CI RESIDENCE NUMBER OF LIVING UNITS: 0 COMMERCIAL NUMBER OF BEDROOMS: Ei OTHER NUMBER OF EMPLOYEES: 0 0 SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATIONSIZE TYPE OF PUMP CI PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) 0 LEACH LINES L LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 J..A L _4 LE V P PAYMENT RECEIVED 0 2(24 A A SAN JOAQUIN DEPART iONMENTAL COUmENNTYT ENvi ICALTH 1; I I I I [ 1 I I I I I I I 1 1 1 1 1 I 1 1 1 1 1 1 1 IIIIIIIIIIIIIM DEPARTMENT USE ONLY Application Accepted By 7.------ 2---Z-- Date /2 10/20470 Area S- /7ic:6 y Employee ID# As Character of Soil to Depth of 3 Ft: \ \ tis-2....0-2..A P/ Final Inspection By s---- Date ERMIT - Approved by 0 SPECIAL Pi ump Soil Character: Joe .1 1i...,M1 to SIGNED DATE 12-14-20 COMMENTS /-3c,o-)0,1 cyr seP" AnYi. TO PE Code SC INFO Received B Check#/ Cash, Amount Remitted Date Permit/ Service Reoluest # Invoice # Permit ID# _qc), I 07S- --/ c, n 415;3.2 Spoo630) ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18