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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 -(209) 468-3420 <br />MON-KEFUNDABLE t'ERMIT t:ALL (LUN) V0J-70&1 PON INSPEG/IONS CAYIKtS T TtAK FKUM UAIIt: ISJUt <br />Joe ADDRESS 2428 Lathrop Rd. CrrylZIP Lathrop <br />CROSS STREET S Airport Way APN !�� PARCEL SIZE <br />OWNER NAME Irvine Wilson PHONE <br />OWNER ADDRESS CITY/STATE/IJP <br />CONTRACTOR West Coast Backhoe, Inc PHONE 209-339-7394 <br />CONTRACTOR ADDRESS 33 Maxwell St. CRY/STATE/LP Lodi CA 9240 <br />LICENSE .J C-42 C-36 OTHER A NUMBER 851157 ExPWATION DATE 2023 <br />D <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIRIADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />- Co IA <br />_ OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROO : 3 <br />NUMBER OF EMPLOYEES: <br />EPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />fl FOUNDATION <br />It PROPERTY LINE <br />fl <br />0 LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />FILTER BED <br />DISTANCE TONREST WELL <br />WIDTH �� ft LENGTH <br />ft FOUNDATION <br />LiD ft <br />ft PROPERTY LINE <br />DEPTH !�tI <br />ft <br />ft <br />DISTANCE TO NEAREST WELLft FOUNDATION C�ft PROPERTY UNE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH It LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />It <br />DEPTH <br />fl <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY UNE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />ft <br />AJC/ <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 />FOR INSPECTIONS <br />SIGNED MILIL TITLE Project Coordinator DATE 2111/22 <br />E ARTMENTUSEONLY d <br />Application Accepted By Data ZArea ` Employee ID <br />Final Inspection By Date : L SPECIAL PERMIT -Approved by <br />Character of Soll to De th of 3 Ft: PI Sump Soil Character - <br />COMMENTS <br />(S-01) <br />ctSe S i S <br />l r r1A : -t7 s ac, a <br />PE Sc Received I CCheck I Amount Date Permrtf Invoice # <br />Code INFO B s Remltte Service Re ues <br />?lel i 1 5 V aw I A2,g7 n '� II.• ni>gm ';X I <br />r <br />42-01 0 JI? <br />4/14/18 Lsker <br />�MFNT <br />1120 7 <br />/N CD 24 <br />y Ou/v�Y <br />Permit IDS <br />M PE7 <br />