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W14 <br />D <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 .(209) 468.3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM UATE 155ULL <br />JOB ADDRESS 105 W. Klo Rd. CITY/ZIP Lathrop, CA <br />CROSS STREET MCnlheey� s /� APN 191-240-20 PARCEL SIZEy <br />OWNER NAME �I • `�,,// ��T [�' ae V ,AA PHONE <br />OWNER ADDRESS r6,t 1I M` CITY/STATE/ZIP 11 �� mil g S 33, <br />CONTRACTOR Mike's Backhoe Service PHONE 209-456-2865 ", <br />CONTRACTOR ADDRESS P.O. BOX 650 CITY/STATEIZIP Manteca, CA 95336 <br />LICENSE C-42 ❑ C-36 OTHER A NUMBER 608554 EXPIRATION DATE 2020 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ PERC TEST # <br />BUILDING PERMIT #", V LAND USE APPLICATION # <br />TYPE OF WORK. <br />NEW INSTALLATION ROPAIRIADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 11>C <br />OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 3 <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG P and L Concrete CAPACITY Ifel l is a <br />o gal # OF COMPARTMENTS 2 <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 100 ft FOUNDATION 10 <br />ft PROPERTY LINE 5 <br />ft <br />LIFT STATION <br />SIZE Ad Of i+1TYPEOFPUMP'6{'µ❑ PKGTXPLANT 0 <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />OF LINE <br />ft <br />EACH LINES <br />LEACHING CHAMBERS # OF LINES" <br />LENGTH <br />DISTANCE To NEAREST WELL 100 ft FOUNDATION 10 <br />ft PROPERTY LINE 5 <br />ft <br />FILTER BED <br />WIDTH �0' ft LENGTH ��r, ft <br />DEPTH I p„ <br />ft <br />DISTANCE TO NEAREST WELL I &I fl FOUNDATION ft PROPERTY LINE_ <br />It <br />❑ MOUNDED <br />WIDTH ft LENGTH ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />fl PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />It DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION 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 />SIGNED Mike Fuller <br />Contractor DATE <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />