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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR/INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRE33 `^I CITY/ZI V1 L P h yh f CROSS STREET /� APN O PARCEL SIZE o 1 �n OWNER NAME / L� Ac?,T ZSeA & -�o b - //7 zo Lodi PHONE OWNERADDRESS !'7/©�j` 1 Y K-��IUIU I��YIl Lo CITY/STATE2L 1P L o N I f�� / 7 T n CONTRACTOR �fZ94Z i✓I U,Cti�-L _��E(�(�I L�� PHONE /YJ ` 1 CONTRACTOR ADDRESS F' LS F�JG `"1 CITY/STATE/ZIP ly'7! CA JET r I LICENSE ❑.1,C-42 ❑ C46 OTHER A NUMBERQQEXPIRATION DATE _�44- Zi WATER TABLE DEPTH: v ft GEOGRAPHICAL INFORMATION: Coordinates X Y J PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/AoornoN ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: �. RESIDENCE IJ COMMERCIAL 2 ❑ OTHER NUMBER OF LIVING UNITS: J r NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG (/Y�Y CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL J ft FOUNDATION U` '7` ft PROPERTY LINE !C-3 ft ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELLft FOUNDATON ft PROPERTY LINE ft ` ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft n' DISTANCE TO NEAREST WELL ft•'FOUNDATION it PROPERTY LINE R SEEPAGE PITS NUMBER WIDTH 3: ft DEPTH ZK, ft DISTANCE TO NEAREST WELL- '��±ft FOUNDATION �� ft PROPERTY LINE 1r) ft / I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. L Wai"��"NCE NOTICE REQUIRED FOR INSPECT19NS-%R6SE CALL(209)953-7fi9 IGNFD TITLE DATE _. pqY RFc�MFNr VFX UN r 5 ?D?0 t 91 IQV/N RpNM CpU GC: Application Accepted By DateOZ b Area Employee I[)# Vf Final Inspection By A4A.—j Date -J1'jV-?d J SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS I n J i u" zZ i t»e- PESC *Recolved Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFOCa Remitted Service Re uest# 42--01 W L- 10/ ( �1418 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT