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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 <br />rVUN-F%rr'U UAtnLr rrKMI I L.ALL (LUV) NDJ-/O`J/ FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUEI <br />JOB ADDRESS 8874 Live Oak Road CITY/ZIP Stockton, 95212 <br />CROSS STREET Alpine Road APN 063-050-19 PARCEL SIZE 3 Acres <br />OWNER NAME Gary Steven Holtberg PHONE 209-938-8419 <br />OWNER ADDRESS _ 8874 Live Oak Road CITY/STATE/ZIP Stockton. CA 95212 <br />CONTRACTOR Dillon & Murphy PHONE 209-334-6613 <br />CONTRACTOR ADDRESS PO Box 2180 CITY/STATEIZIP Lodi, CA 95241 <br />LICENSE ❑nC-42 .❑--C-36 OTHER NUMBERLI5 Z� EXPIRATION DATE <br />WATER TABLE DEPTH: <br />It GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />�( <br />PERC TEST # 1 <br />BUILDING PERMIT# <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />f I NEW INSTALLATION 7 <br />REPAWADDITION <br />F1 ENGINEER DESIGNED /ALTERNATIVE <br />1 REPLACEMENT ❑ <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />❑ DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />It PROPERTY LINE ft <br />❑ <br />LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKGTXPLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH It LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH It LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT <br />I 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 />MINIMUM 4A <br />HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL(209) -76697 <br />SIGNED <br />TITLE Staff <br />DATE 1Z L$/Zd2I <br />_ DEPARTMENT US ClNL <br />Application Accepted By l G <� G Date P Area Employee ID# fc" I ,I <br />Final Inspection By Date ( 1 i6 "ZZ SPECIAL PERMIT -Approved by � � <br />Character of Soil to Depth of �Pii�USump Soil Cha acter: <br />COMMENTS (L� rL %l'�C -; t� .A n._ w `: <br />slw ft - <br />8 ?0?1 <br />5C Received Gh Amount Permit/ (Ir <br />INFO B ash Remitted Date 1 Service Request # Invoice # <br />5 �3 ► 5 � 25Y X � � "r�qp „T�C <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />