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c <br /> f <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 5573 Woodbndge Road CITy/ZIP Lodi/95242 ✓: <br /> CROSS STREET Ray Road APN 011-170-52 PARCEL SIZE 45.11 Acres Y <br /> b <br /> e <br /> OWNER NAME Allen Lombardi PHONE(209)810-0058 m <br /> OWNER ADDRESS 7581 W.Kile Road CITY/STATE/ZIP Lodi/CA/95241 <br /> CONTRACTOR Dillon 8 Murphy PHONE(209)334-6613 <br /> CONTRACTOR ADDRESS P.O.Boz 2180 CIN/STATE/ZIP Lodi/CA/95241 <br /> LICENSE [IFIC-42 ]FIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> P9 PERC TEST # 1 1 BUILDING PERMIT# LAND USE APPLICATION#Pa-1800279 <br /> TYPE OF WORK: FF NEW INSTALLATION Fl REPAIR/ADDmON I1 ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT ❑ OUT-0F-SERVICE SEPTIC SYSTEM i I DESTRUCTION <br /> INSTALLATION WILL SERVE: J RESIDENCE ❑ COMMERCIAL l, OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> (3 LEACH LINES 11 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE IT <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH IT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 4 UR C TI /RED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED 'r TITLE Party Chief DATE 5/6/19 <br /> O <br /> AYflAEiVT <br /> RECEIVED <br /> AY 0 7 2019 <br /> —tv, JOAQUIN COUNTY <br /> -IPIVIRONMENTAL <br /> fis'li DEPARTMENT <br /> DEPARTMENT SE NL <br /> Application Accepted By Date AreaEmployee ID# <br /> Final Inspection By t +- Date J SPECT L PERMIT-Approved by <br /> Character of Soil to-pepth of 3 Ft. Pit/Sump Soil Character: <br /> COMMENTS I C, 4J;'11""") �'L ��,��5 {7ti /IC4 <br /> PE SC Received Check#/ Amount ate Perini Invoice# Permit ID# <br /> CodeINFO C s Remitted Service Re uest# <br /> If <br /> z S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />