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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 9296 E. State Highway 12 CITY/LP Lodi / 95240 <br />CROSS STREET Locust Tree APN 051-120-56 PARCEL SIZE 13.2 Ac. <br />OWNER NAME Chris & Diane Knoll PHONE (209) 3340450 <br />9296 E. State Highway 12 CrrY/STATE/ZIP Lodi / CA / 95240 <br />OWNER ADDRESS <br />CONTRACTOR Dillon & Murphy PHONE (209) 3346613 <br />CONTRACTOR ADDRESS P.O. Box 2160 CrrYISTATE/ZIP Lodi / CA / 95240 <br />LICENSE _ CO2 7 . C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinata5 X Y <br />PERC TEST # 2 BUILDING PERMIT # LAND USE APPLICATION #PA Isco— <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: _ RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMeER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPEJMFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TXPLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />(3 LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />It <br />❑ FILTER BED Wa)TH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SUMPS WIDTH It LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH <br />it <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />1 HEREBY CERTIFY THAT I HAVE <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />.................�...r. w n.0 unc untarc-ZSC^t IIocn CAO IIUSOFrTInNS - PI FA SF CALL (209) 953-7697 <br />SIGNED <br />Application Accepted <br />ftYdZqf- <br />Final Inspection By <br />Character of Soll to elpth of,3 <br />COMMENTS <br />Party Chief DATE 9-11-16 <br />Jam, J m ® 6fF L ty <br />1 ! <br />494.JCA <br />TMEN USEONLY <br />C L <br />Date � � " I Area � Employee ID# wo � <br />Date ❑ SPECIAL PERMIT - Approved by <br />Pit(Sump Soli Character: — <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />