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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NUN-KEFUNDABLE PERMIT (:ALL JOB ADDRESS 1410 Frewert Road CROSS STREET Manth 953-7697 FOR INSPECTIONS tXPIRES l YEAR FROM UATE ISSUE CITY/ZIP Lathrop APN 191-270-21 PARCEL SIZE 92.39 OWNER NAME I Gj G i C'1 C �N C PHONE / OWNER ADDRESS N P" 'ivA CITY/STATE/ZIP itf e --, f / UI z 23 o 2 CONTRACTOR Terracon Consultants / Aaron Mejorado '�`PHONE 209-367-3701 CONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/ZIP Lodi/CA/95240 LICENSE C-42 C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06/30/2022 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # 6 BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS Received By 1--aec"V # OF LINES Pate DISTANCE TO NEAREST WELL Permit ID# ft FOUNDATION ❑ FILTER BED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 digN. itally signet by Woods. T -1.K TITLE Staff Scientist /Consultant DATE 03-31-2022 SIGNED Woods Tamara DN cn=Wooes. Tamara JPM 1410 FRENERT ".0 PROPOSED SEPTIC LATHROP CA 95330 _ „{ SYSTEM V, APN, 191-270-210 T EXISTING SEPTI SYSTEA ,EnC — I . EXISTING SEPTIC _I I' SVSTEM1i PROPOSED SEPTIC .� SYSTEM #2 I I I I I I I 1 I I I I I I / DEPARTMENTUSE ONLY Application Accepted B z— L-- Date 4 / � Area �/ Employee ID#� Final Inspection By Date f U - SPECIAL PERMIT - Approved by Character of Soil to Dep h of 3 Ft: Pit/Sump Soil Character: COMMENTS G��3��a - !TA ,-f,�r C,:I let's, "Jilfei e11 ;1jt?&O C4 Cee,, Ili,10IJ C. faLj;7, PE Code SC INFO Received By 1--aec"V Amount Remitted Pate Permit/ Service Request # Invoice # Permit ID# Wawa sa32(�1.= I ,I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T