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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 N JOB ADDRESS , State Route 88 CITY/ZIP Clements/95227 CROSS STREET Liberty Rd. APN 009-300-18 PARCEL SIZE 48.9 Ac. OWNER NAME LWB Development Inc PHONE OWNER ADDRESS 8102 Kelly Dr., #C CITY/STATE/ZIP Stockton/Ca/95209 CONTRACTOR Dillon & Murphy PHONE (209) 334-6613 CONTRACTOR ADDRESS PO Box2180 LICENSE 11C-42 ❑_C-36 OTHER NUMBER RCE 45277 �U�eoYr /Sr Zip Lodi/Ca/95241 DATE ` 13J & y T ❑ LEACH LINES C LEACHING CHAMBERS DISTANCE TO NEAREST I ❑ FILTER BED WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y ly PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE WELL 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 TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES C LEACHING CHAMBERS ft # OF LINES LENGTH OF LINES It FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION DISTANCE TO NEAREST WELL ❑ FILTER BED WIDTH ft LENGTH DEPTH DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH ft LENGTH It FOUNDATION DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft LENGTH DEPTH DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft LENGTH ft FOUNDATION DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER WIDTH_ DEPTH DISTANCE TO NEAREST WELL ft # OF LINES LENGTH OF LINES It FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft / It FOUNDATION ft PROPERTY LINE ft ft DEPTH Sq� u ft FOUNDATION ft PROPERTY LINE ft DEPTH 'IGT ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION 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. DEPARTMENPUS ONLY Application Accepted By Data iii Area L) Employee ID# F P, Final Inspection By (4.65q92212Date IiO2`Ih2 _ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Chec Amount Date Permit/ Invoice # Permit ID# Code INFO B Remitted a uest 9,;a� S a 3 /S4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 0 0 RF y4f, 100 13 9 Z�z1 RpAt 00v �FpgR MFN