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/jidm <br />%viM y <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-KEFUNDABLE PERMIT (:ALL (LU,9) ,90:f -/t19/ FOR INSPECTIONS <br />tXPIRES 1 TEAR FROM UATE ISSUE <br />JOB ADDRESS <br />12023 E. BRANDT ROAD <br />CITY/ZIP LOCKEFORD, <br />CA 95237 <br />CROSS STREET <br />LOCKE ROAD APN 051-320-08 <br />PARCEL SIZE 2.32ACRES <br />OWNER NAME <br />LARRY WOODS <br />DISTANCE TO NEAREST: WELL <br />PHONE 209-603-0794 <br />OWNER ADDRESS _9834 <br />FERNWOOD AVENUE <br />CITY/STATE/ZIP STOCKTON, CA 95212 <br />CONTRACTOR <br />TERRACON CONSULTANTS <br />INGHONE <br />209-367-3701 <br />CONTRACTORADDRES''� <br />902 INDUSTRIAL WAY <br />CITY/STATE/ZIP <br />LODI, CA 95240 <br />LICENSE ❑ C-42 _ C-36 OTHER C57 NUMBER669004 EXPIRATION DATE 5/31/2017 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION <br />X PERC TEST # _1 I BUILDING PERMIT # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADI <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />Coordinates X Y <br />LAND USE APPLICATION <br />GNED/ALTERNATIVE <br />INSTALLATION WILL SERVE: 71 RESIDENCE :1 COMMERCIAL -1 OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />Date Permit/ Invoice # <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />0� <br />Service Re uest# <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ 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 />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <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 />❑ 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 ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS <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 />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />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 24 HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />;'rlla 1;(V- <br />TITLE STAFF SCIENTIST <br />DATE _ 03-01-2017 <br />orae <br />Application Accep <br />FinallnspecUon E4 <br />Character of Soil to <br />COMMENTS / <br />of 3 <br />APPROXIMATE <br />PERCOLATION TEST <br />LOCATION WITHIN <br />THE EXISTING <br />LEACHFIELD <br />WCUTY MAP <br />W.1 -S <br />r,, <br />Q <br />Received <br />Check#/ <br />Amount <br />Date Permit/ Invoice # <br />Permit ID# <br />Code INFO <br />Q <br />as <br />0� <br />Service Re uest# <br />z <br />2 <br />r <br />DEPARTMENT LY <br />Date Area Employee ID#�O <br />Date SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />PE SC <br />Received <br />Check#/ <br />Amount <br />Date Permit/ Invoice # <br />Permit ID# <br />Code INFO <br />By <br />as <br />Remitted <br />Service Re uest# <br />z <br />2 <br />3/ z -1 EK00 (90 <br />42-01 <br />4/24/12 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />