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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1869 E.HAZELTON AyENuE-STOCKTON CA 95205-[209]468-420 <br /> NON-REFUNDABLE PERMIT CALL 09 953-7697 FOR 1NSPEC Toms <br /> Jos ADDRESS W20 122124 E.Butler Ln EXPIRES !YEAR FROM DATE ISSUED <br /> g <br /> 11 TylaP Linden 95236 <br /> CROSSSTREET Aewe-' <br /> APN 09 03M2 PARCEL&Dt 2.73 Ae. a <br /> OWNER NAME Judie Rivera e <br /> OriNER PHONE (209)470-0024 <br /> G�TYlSTATE/ZIP (J-A&L i•.3 H <br /> CoNTRACTO& Live Oak GeoEnvironmental PHONE (209)369-0375 <br /> CONTRACTOR AODRC$S 407 W->Oak St. <br /> C"IsTATFJZIP Lodi,CA 95240 <br /> LICENSE ❑CC-42 ❑OC-36 OTER CEG NUMBER 2151 <br /> — ExwRATON DATE 4Cd0/26 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMAhON: Coordinates X <br /> PERC TEST # Y <br /> BUILDING PERMIT 9 LAND USE APPLICATION•TYPE OF WORE(: C NEW INSTALLATION <br /> C REPAEIt1AD01TEON 2ENGINEER DESEGNEDIALTEREYATTYE <br /> C REPLACEMENT C. OUT-DFSEFI SEPTIC SYSTEM <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE - DESTRtICTON <br /> ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNrrS: NUMBER OF BEDROOMS: <br /> NuiiI of EMPLOYEES: <br /> O SEPTIC TANK TrpFIMFG <br /> 0 GREASE TRAP TrpFJMI=G CAPACITY 9V f OF COIAPARTMENT3 <br /> CAPACrTY gal #OF COMPARTMENTS <br /> DISTRNCE Tp NEAREST: WELL ft FOVNDRTIDN <br /> ❑ 11FTSTATTON SIZE ft PROPERTY LINE ft <br /> TYPE OF PUMP 0 PKG Tx PLANT SAHp OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 7 LEACHING CHAMBERS <br /> #DF IJNES_ _ LENGTH OF LINES It <br /> DISTANCE To NEAREST WELL R FOUNDATION <br /> ❑ FILTER BED WOTH �R PROPERTY LINE ft <br /> R LENGTH R DEPTH R DISTANCE To NEARFs r WELL III FOUNDATIONE`❑ MOUNDED WIpTH R PROPERTY LINE_ <br /> ft <br /> R LENGTH R DEPTH DISTANCE To NEAREST WEL ItL ft FOUNDATION❑ Sumps R PROPERTY UNE ft <br /> WbTH R LENGTH <br /> ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNIOI <br /> ❑ DISPOSAL PONDS WIDTH ft PROPERTY LINE ft <br /> ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION <br /> ❑ SEEPAGE PITS NUMBER R PROPERTY UNE_ R <br /> WIDTH R DEPTH DI NCE TO NEAREST WELL ft FOUNDATION <br /> ft <br /> R PROPERTY UNE tt <br /> I HEREBY CERTIFY THAT I HAYS PREPARED THIS APPL1CA-DON AND T1IE WORK WILL BE STATE LAWS PONE IN ACCORDANCE WITH SAN JORDVIN COUNTY DRDINANCES, <br /> III AND RULES AND RFGULATIONS OF SAN JOAgVIN COUNTY_ <br /> V OT CE RE lf2E F R! ON -PLEASE tt 2U 3-T 7 <br /> SIGNED TITLE Project Manager Z-7-3- 2-DATE CC <br /> �Cs <br /> z� <br /> Application Accepted 8y f ❑EP RTMEN S NL Date 4. <br /> Area Employee ID# <br /> Final Inspection By bate <br /> Character of Soii to Depth of 3 Ft: C SPECIAL PERMIT-Approved by <br /> COMMENTS PdMump Sail Character <br /> PE SC Received hec Amount <br /> Code INFO ash Remitted Daft Permit! Invoice# Permit ID# <br /> Service vest# <br /> 42-01 <br /> 4114I18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />