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e <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 DATE ISSUED <br /> JOB ADDRESS 20797 E.Frazier Rd. CRv21P Linden 95236 w <br /> CROSS STREET Clements APN 065-190-12 PARCEL SIZE 10-OAC- <br /> OWNER <br /> 0.0Ac.OWNER NAME Randy Marston PHONE(209)321-6327 <br /> OWNER ADDRESS 17170 E.Front St. CITY/STATE/Zlp Linden,CA 95236 <br /> CONTRACTOR Live Oak GeoEnvironmental PHONE(209)369-0375 <br /> CONTRACTOR ADDRESS 407 W Oak St. CrTY/STATE/Zlp Lodi,CA 95240 <br /> LICENSE 7 C-42 L','.:C 36 OTHER CEG NUMBER 2151 EXPIRATION DATE 4/30/24 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION : REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE -.i COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 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 R DV E NQ TI E REQUIRED FOR INSPECTIONS-PLEASE CALL209)953-7697 <br /> SIGNED TITLE Project Manager DATE 1/1,/23 <br /> IL <br /> 11 1 11 1 INN <br /> ) t <br /> PARTMENT I&E 0 LY A <br /> Application Accepted By Data Area Employee ID# A,q <br /> Final Inspection By Date - f_1 SPEC/ PERMIT-Approved by <br /> ��Character of Soil to Depth 13 Ft: Pit/Sump Soil Character: <br /> COMMENTS 2.1-5t-Q '5:".� "- tz ltL lr'-, �PkSSli7 S. 43 <br /> T� <br /> PE SC Received Choc Amount Permit/ <br /> Code INFO B h emitted Date rvice Request#q Invoice# Permtt ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />