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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-SToclrroN CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 09 953-769 7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 7001 E.Southland Rd. gnmp Manteca95336 <br /> H <br /> CROSS STREET Mi[Chell APN 218-070-03 PARCEL SLZE 2.14 Acre <br /> a <br /> OWNER NAME Gary Glendenning PHONE( �209 450-5112 <br /> OWNER ADDRESS Sarne CITYISTATEMP <br /> CONTRACTOR Live Oak GeoEnvironmental PHONE (209)369-0375 <br /> CONTRAcrOR ADDRESS 407 W.Oak St. CRYISTATEfLJP Lodi,CA 95240 <br /> LICENSE 01-%C-42 0-C-36 OTHER CEG NUMBER 2151 ExPIRATIONDATE 4)3OJ28 <br /> WATER TABLE DEPTH: ft GEOGRAPWCALINFORMARON: Coordinates X Y <br /> � PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK' _ NEW INSTALLATION _ REPAIRfADDITION . ENGINEER DESIGNED IALTERNATIYE <br /> REPLACEMENT OUT-OF-S E RME SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER Of LIVING UNITS: NUMBER OF BEDROOMS: HUNKER OF EMPLOYEE$; <br /> 0 SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTs <br /> O GREASE TRAP TYPEIMFG CAPACTY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP Q PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> A LEACH LINES - LEACHING CHAMBERS OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED Wo,-H ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION n PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH n LENGTH —I ft DEPTH It <br /> DISTANCE TO NEAREST VVELL ft FOUNDATION ft PROPERTY UNE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORTS WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN CO U N TY- <br /> VE ADVANCENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 9 953-7697 <br /> SIGNED �� TITLE Project Manager DATE <br /> I <br /> I <br /> 1 <br /> c <br /> 13 <br /> D PARTMENT je Ofi LY (� AYME14T <br /> Application Accepted By Date Area ! Employee ID#��E�■'E` <br /> Final Inspection By_ Date ❑ SPECIAL PERMIT-Approved by Y fD <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character: <br /> COMMENTS APR [� ,y 2026 <br /> EN �QUIN COUNTY <br /> PE SC Receiv6d �; eckv -Amount Permit/ ONMENTAL <br /> Code INFO 'Cal Remitted Date Service R uest# Invoice it Pe TH DEPgRTMINT <br /> 42-01 ON SITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114116 <br />