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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 RUN-Rtt-UNUAt$Lt PtKMI I JOB ADDRESS 21718 N. Cord Road L.ALL `JDJ-10&f FOR INSPECTIONS tXPIRES 7 YEAR FROM DATE CITY/ZIP Clements, CA 95227 CROSS STREET Highway 12 APN 023-200-05 PARCEL SIZE 87.4,1 Ac OWNER NAME Rick McCarty PHONE (209) JCCIL.( OWNER ADDRESS 21718 N. Cord Road CITY/STATE/ZIP Clements, CA 9522277 1 CONTRACTOR Dillon & Murphy, C/O Joe Murphy PHONE (209) 334-6613 CONTRACTOR ADDRESS PO BOX 2180 CITY/STATE/ZIP Lodi, CA 95241 LICENSE 111IC-42 :1 C-36 OTHER RCE NUMBER 45277EXPIRATION DATE 09-30-2022 — –IAF,. WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #PA -2000199 TYPE OF WORK: fl NEW INSTALLATION F] REPAIR/ADDMON I i ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ OUT -0F -SERVICE SEPTIC SYSTEM C DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) O LEACH LINES Ll LEACHING CHAMBERS #OF LINES Amount Permit/ DISTANCE TO NEAREST WELL ft FOUNDATION_ ❑ FILTER BED WIDTH It LENGTH ZI DISTANCE TO NEAREST WELL ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL R FOUNDATION LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH It R PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE It ft DEPTH ft It PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH It ft PROPERTY LINE ft I 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. DEPARTMENT OS ONLY Application Accepted By Date 4 ' / Area li (% Employee ID# tl� Final Inspection By %sct✓� -.a l l ,:- ;_{ ._ 1�,,..i •L Date t(fi4i7:£ I ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/ Code INFO B Cash Date Invoice # Permit ID# Remitted Service Re uest # LI S ,3 ? ZI 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 '� MENT ECEIVED 3 2021 IOAQUIN COUNTY VIRONMENTAL TH DEPARTMENT