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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 18B8 E.HAZELTON AVENUE-STOCKTON CA S6205-(209)468-3420 <br /> 14ON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPEC7fONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AOORESS 9198 W.Lorraine Rd. crTymp Tracy 9S377 <br /> CROSS STREET MacArthur APN 248-060-22 <br /> PARCEL S4E 0.97 AC- >7 <br /> OWNER NAME Iherson Lopez c/o Joe Mendoza PHONE [2+ ]882-6288 <br /> OWNER ADDRESS Same CITY/STATEOP aC <br /> CONTRACTOR Live Oak GeoEmAronmental PHONE (209)3 0375 <br /> CONTRACTOR ADDRESS 407 W.Oak SL CrTY/STATE ZIp Lodi,CA 95240 <br /> LICENSE. ❑:^--C-42 CCC-m OTHER GEG NUMBER 2151 ExPIRAnpN DATE 4M/26 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates I[ y <br /> PERC TEST # T BUILDING PERMIT IF LAND USE APPLICATION� <br /> TYPE OF WORK: G HEW INSTALLATION ❑ REPAIRIAOOmON 7 ENGINEER DESIGNEDIALTERNATNE <br /> C REPLACEMENT C OUT-OF-SF RVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL {] OTHER <br /> NUMBER OF LnANG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> 4 GREASE TRAP TYPEIMFG CAPACITY gal 0 OF COMPARTMENTS- <br /> DISTANCE TO NEAREST. WELL It FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFTSTATIOH SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR[ENCLOSED SYSTEM] <br /> O LEACH LINES ❑ LEACHING CHAMBERS i OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOJNDATION fI PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TD NEAREST WELL It FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LI SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL-'ft FOUNDATION ft PROPERTY LINE ft <br /> T HEREBY CERTIFY THAT I HAVE PREPARED THIS APPL CATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> M1Af1MUM 4 ADVAMCE N012CE REQVfRED FORP fit P TI S-PL ASE CALL 209 -76 7 <br /> SIGNED TITLE Project Manager DATE ;,,, <br /> r ;A <br /> n0 d D <br /> Gy <br /> Alf <br /> ex - D ARTM T N y <br /> Applica[ioll Accepted By ❑ate 2 y Area r j°t Employee ILbF � <br /> Final inspection By Date ❑ SPECIAL PERMIT-Approved 6y <br /> Character of Sail to Depth of 3 Ft "LIMP SOU Character. <br /> COMMENTS <br /> PE SC Received <br /> __Rode INFO sh Remitted Date Service R uast Ik Invoice IF Permit ID* <br /> •[� S f�D� <br /> 42-01 <br /> 411V1e ONSfrE WASTEWATER TRTMNT SYSTEM PERMIT <br />