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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 488.3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1410 FrewertRoad CITYRJP Lathrop CROSS STREET Manthey -(' APN 191-270-21 PARCEL SIZE 92.39 OWNER NAME/�� ff' �GI C G 1'CT �L-F'1 Cl• > /�1,PHONE OWNER ADDRESS L' P h I 1 P." tof j � CrTY1STATEMP A thFpS / ter'' ' CONTRACTOR Terracon Consultants / Aaron Mejorado PHONE 209-367-3701 CONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/bp Lodi/CA/95240 LICENSE ❑ C-42 ❑ C-38 OTHER PE NUMBER 72446 EAPIRATION DATE 06/3012022 WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # B I BUILDING PERMIT # DISTANCE TO NEAREST WELL LAND USE APPLICATION # TYPE OF WORK: - NEW INSTALLATION REPAIR/ADDITKIN ENGINEER DESIGNED /ALTERNATIVE DISTANCE TO NEAREST WELL REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE U COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFO CAPACITY gal # OF COMPARTMENTS R DEPTH it DISTANCE TO NEAREST: WELL it FOUNDATION it PROPERTYLINE it ❑ LIFT STATION SIZE TYPE OF PUMP O PKD TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) O LEACH LINES LEACHING CHAMBERS # of LINES LENGTH OF LINES R ................. DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTYLINE ft ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft ■■■■■■■■■■�riiLL�'7■ ■■■■■■■■R"Mmsev■■ DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTYLINE R ❑ MOUNDED WIDTH ft LENGTH R DEPTH R DISTANCE To NEAREST WELL it FOUNDATION R PROPERTY LINE it ❑ SUMPS WIDTH it LENGTH R DEPTH it DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH it LENGTH R DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION N PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 SIGNED Woods. HOUR ADVANCE NOTICE REQUIRED ua�+r•a.e rim. r.�,■ Tamara ��+�� K eseewtrowi. FOR INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE Staff Scientist /Consultant DATE 0331-2022 DEPARTMENT E ONLY Application Accepted By �� G Z-- Dats 4 / Area Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE ................. Illi ................. .. 1 , r 7a tfl ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■fG■■■■■ EXISTINGSEPTiC ■■■■■■■■■■■al7rmpm ■■■■■■■■■■Vi 3,!Ii1L/■ L�aaa ■■■■■■■■■■�riiLL�'7■ ■■■■■■■■R"Mmsev■■ SYST PROPOSED SEPTI ■■■■■■■■■■■■O&ORM ■■■■■■■■■!■■■■■■■ IMMMMINIMMMMININIMISMIMMIN ■■■■■■■■■m■mm■m■■ DEPARTMENT E ONLY Application Accepted By �� G Z-- Dats 4 / Area Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received ec Amount ate Permit/ Invoice Ill PermltIOX Code INFO B Remitted Service Request # L�aaa saz Z7Co 12SL 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118