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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONVENTAL HEALTH DEPARTYENrT 1868 E.HAZELTON AvENUE-STOCKTON CA 95205-(209)466-3420 <br /> HON-REFUNDABLE PERMIT CALL Mpj 953-7697 FOR INSPECTIONS ExPIRES 1 YEAR FROM LATE ISSUED <br /> JOB ADDREW 17050 E.LOM Tree Rd- Crn.ILP Escalon 95320 <br /> CROSS STREET MurPhy APN 203-210-05 PARCEL Stm 90 Acres <br /> OWNER NAME David d Shenie Ven Vllet PRONE(209)889-1212 <br /> OWNER ADDRESS 9.0-30)r720 CnvISTATE72w Ripon,CA 95388 <br /> CONTRACTOR Lire Oak GeoEnvironmental pHUM(209)369.0375 <br /> CONTRACTOR,ADDRESS 407 W.Oak St. CITrISTATEtaP Lodi,CA 95240 <br /> LICENSE ❑UC42 ❑nC-IS OTmER CEG NUMBER 2161 Exm noN DATE 4MI24 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL IrFORYAT1p1: Coordinates X Y <br /> PERC TEST B 2BUILDING PERMIT 9 LAND UsE APPLICATION A <br /> TYPE OF WORIL F1 NEW INSTALLATION ❑ REPAtWADDM ON D EMQ*iFER DEatGMED1ALTERMATNE <br /> Li REPLACEAFNf IJ OOT-OFSEMACE SEPTIC SYSTEM ❑ DESTRwCToN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> HUMBER OF LIVING UNITS: HUMBER OF BEDROOMS: NUMBER OF EMPLOYEES! <br /> 13 SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> 13 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST-. WCL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LOFT STATION SIZE TYPE OF PUMP O PKG TX PLANT I] SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES L LEACHING CHAMBERS *or L IMM LENGTH OF LONES ft <br /> DISTAMCE To NEAREST WELL. ft FOUNDATION A PROPERTY LINE ft <br /> ❑ FILTER 8ED vd T ft LENOTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEMEST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft A <br /> DISTANCE TO NEAREST WaL ft FOLINDATION R PROPERTY LINE R q <br /> ❑ SEEPAGE PITS NUMBER War" ft DEPTH <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT f HAVE PREPARED 71115 APPLIGATIGN AND THE WORK IMLs REDONE IN ACCORDANCE 71YTTH&AN JOAQUIM COUNTY ORDINANCES, l6 <br /> STATE LAWS AND RULES ANO REGULATIONS OF SAH JOAQUIN COUNTY. <br /> M MiUM 4M&R ADYaNdPIVOTICE REQUIREDR INSPECTIONS-PL 0 <br /> SIGHED TITLE PMJ@CtMS-g- _ DATE 2/X23 N�DNQ �� <br /> (fj .]�3 <br /> � a I <br /> 1 � <br /> q I� <br /> 4f, 0(jiv <br /> IP <br /> s SII <br /> R I s <br /> I <br /> a <br /> k � I <br /> $ " I <br /> 4 I <br /> IIT--- — – I`I <br /> Application Accepted Sy pats Area r ■ Empiayee IDD <br /> Final Inspection By Dad ❑ SPECIAL PERMIT-Approved by <br /> Character of SON to Depth of 3 Ft: PAMump Soil Characdr- <br /> COMIuIENTS <br /> PE SC RaealwdCheck Ar <br /> Amount Dah Permkl lnvWw# Permit 1018 <br /> Code INFO Remitted S�rvlp R ueet/ <br /> za sa 5RO (0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4 V18 <br />