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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 18U E.HAZELTOR AVENUE-STOCKTON CA 95205-(209)4694420 <br /> NON-REFUNDABLE PERMIT CALL W9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 29534 S.Chrisman Rd. C1TY1zP Tracy 95304 st, <br /> m <br /> CROSS STREET Linne APN 253-230-06 PARCEL SIZE 1-0 Acre G <br /> 0 <br /> OWNER NAME Jesus Ureno PHONE <br /> OWNERADDRESS Same C;TYfSTATEf71P <br /> CONTRACTOR Live Oak GeoEnwonmental PHONE (209)369-0375 <br /> CONTRACTOR ADDRESS 407 W.Oak St. CITYISTATElGP Lodi,CA 95240 <br /> LICENSE []'-�C-42 0-�C36 OTHER C:EG NUMBER 2151 ExnRATIONDATE 4)3Or26 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST If ' $UILOING PERMIT 0 LAND USE APPLICATION$ <br /> TYPE Of WORK: C NEW INSTALLATION REPAIRIADDInoN ENGINEER DESIGHEDIALTERNATNE <br /> I. REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM - DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q SEPTIC TANK TYPEIMFG CAPAGTY gal vor COMPARTMENTS <br /> O GREASE TRAP TYPE)MFC CAPAGTY gat i OF COMPARTMENTS <br /> DISTANCE TO NEAREST. WELL ft FOUNDATION ft PROPERTY LINE h <br /> ❑ LIFT STATION SIZE TYPE OF PUMP D PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF tINEs LENGTH Of LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ SUMPS WIDTIJ ft LENGTH ft DEPTH tt <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE tt <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE- It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THUS APPL CAT10N AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY- <br /> MINIPWUW a AbV2 A QyAPjCEN0T10E REQUIRED EQR WN PECTI N -PLEASE CALL 09)9,53-7697 <br /> SIGNED i i - TITLE PrOjeCt Manager DATE <br /> i <br /> A'4 <br /> DEPARTUEN7 WS O OILY <br /> Application Accepted By / Date Area �� Fsnployee IDF <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved Dy <br /> Character of Soil to Depth of 3 Ft: Pittsump Soil Character. <br /> COMMENTS <br /> PE Sc Received eC Amount Date PermN <br /> Invoice# Permit IDp <br /> Code <br /> y INFO <br /> +� B h Remitted Service UestM <br /> 42-01 ONSFE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />