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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1568 E.H-TON AVENUE-STOCKTON CA 9520S-(209)4683420 NON-REFUNDABLE PERMIT CALL 953-7697 FOR flYSPECTI❑A13 EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS 20795&20295 S.Van Allen Rd. crryrbP Escalon,CA 95320 n CROss STREET E.RiyeT Rd. APN 245-120-14 0° PARCEL SIZ Y v CmrNER NAME Christine Anderson to PHONE(209)481-539T � ❑wNER ADoREss 20295 S.Van Allen Rd. CLTYISTATEfdIn E -C t:L�p yl [- G ��J CONTRAcroR Live Oak GeOEnvirOnmental PHONE (209)369-0375 ! CONTRACTOR ADDRESS 407 W.Oak St- CITYISTATEMp Lodi,CA 95240 LICENSE CIEC42 07C-36 OTHER CEG NUMBER 2151 EIIPIRATION DATE 4130)28 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates J( y PERC TEST # I BUILDING PERMIT# LAND USE APPi.ICATION# TYPE OF WORK: _ NEW INSTALLATION G REPAIRIADomoN . ENGINEER DESIGNED IALTERNAT[VE C REPLACEMENT C OUT-OF-SERVICE SEPTIC SYSTEMo [IESTRUC110N INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑VOHHER NUMBER OF LINNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES- ❑ SEPTICTANK TYPFJMFG CAPACITY gal #OF COMPARTMENTS O GREASE TRAP TYPEIMFG CAPACITY gel #OF COMPARTMENTS DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE IS ❑ LIFTSTATiON SIZE TYPE OF PUMP D PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OP LINES LENGTH OFLINES ft DISTANCE TO NEAREST WELL It FOL1NDAnON ft PROPERTY LINE It ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOVNOATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH R DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY L NE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft O DISPOSAL PONDS w]oTH R LEN¢TH ft OEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE {t O SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft I HEREBY CERPFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE CONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. Aa N NOTI RE UIR FOR 1 PE NS-P EASE CRLL 2 9 95 - SIGNED r%�r , TITLE Project Manager DATE - 3 RTMEN ❑ Y Q ✓I'AY/�AIR a_T Application Accepted BY Date a 5 L Employee ID#F� r r�E'�@/ Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of S Ft: PiUSump Soil Character, COMMENTS +` SAU $il U PE sG Received hec Amount Penniu t[� � co Code INFO �a itlBd Date Service Uest# Invoice Perrni At 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118