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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-KEFUNDABLE PERMIT CALL JOB ADDRESS 23982 Village Dr. & 29450 State Route 88 CROSS STREET Liberty Rd OWNER NAME LWB Development do Garrett Becker OWNER ADDRESS PO Box 145 CONTRACTOR Dillon & Murphy c/o Joe Murphy CONTRACTOR ADDRESS PO BOX 2180 INSPECTIONS EXPIRES 1 YEAR CITY/ZIP Clements/95227 009-300-06 & 11 PARCEL SIZE 16211 -AC. PHONE (209)604-2222 CRY/STATE/ZIP Linden/CAJ95236 PHONE (209)334-6613 CITY/STATE/ZIP Lodi/CA/95241 LICENSE 11C-42 ❑_C36 OTHER NUMBER RCE 45277 EXPIRATION DATE 9/30/22 D WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y XJ PERC TEST # 3 BUILDING PERMIT# LAND USE APPLICATION # TYPE OF WORK: _ NEW INSTALLATION _ REPAIRIADDITION _ ENGINEER DESIGNED/ALTERNATIVE It FOUNDATION _ REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS ❑ MOUNDED DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It Ll LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES C LEACHING CHAMBERS -# OF LINES LENGTHOFLINEs ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE To NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It 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. SIGNED �� r TITLE Party Chief DATE 1/12/22 tYMENT CEIVED N 12 2022 AQUIN COUNTY RONMENTAL IDEPARTMENT Application Accepted Final Inspection By_ Character of Soil to1) COMMENTS T7 ❑ SPECIAL PERMIT -Approved by Soil Character: a/4 , PE SC Received Check#/ J Amount Permit Code INFO C sh Remitte Dat Service Re uest # Invoice# PermitlD# Pi +12A� vv/1J1 CvvHl 4/14/18 ttr( IKIMNI bTblMYtKMl1