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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 /> Joe ADDRESS 13550 Highway 12 Cm/LP Lodi,CA 95242 w <br /> CROSS STREET Potato Rd. APN 055-020-02%JW PARCEL SIZE 12.0 g <br /> 0 <br /> OWNER NAME Joe,Grindstone Association PHONE <br /> OWNER ADDRESS 1029 N.Country Club CITY/STATE/ZIP Stockton,CA 95204 <br /> CONTRACTOR T2Condwdon PHONE(209)617-0945 <br /> CONTRACTOR ADDRESS 2475 Dunn Rd CIN/STATE/hp Meroed,CA 95340 <br /> LICENSE ❑ C-42 ❑i C-36 OTHER L? 6m/rC,' NUMBER S57LOEXPIRATION DATE -2 —,? I <br /> WATER TABLE DEPTH: 12 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: I I NEW INSTALLATION I I REPAIR/ADDITION I I ENGINEER DESIGNED/AL RNATIVE <br /> W t <br /> AX REPLACEMENT W Holding Tank I 1 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL Id OTHER Fate Campground <br /> NUMBER OF LIVING UNITS: 0 NUMBER OF BEDROOMS:0 NUMBER OF EMPLOYEES:1 <br /> ❑ SEPTIC TANK TYPE/MFG CAPACrrY gal #OF COMPARTMENTS <br /> O GREASE TRAP TYPE/MFG CAPACnv gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST. WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 11 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE it <br /> 0 MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE 1b NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 /> IdAt"ht <br /> PLEASE CALL(209)953-Z§9 <br /> SIG TITLE DATE <br /> RF yV <br /> CF�V�D <br /> JUS 3 0?�?0 <br /> S E E A T T A C H E D P L A N S A N D SJUIBMITTALS Oq Q(J/ <br /> THOF EVL7)4L <br /> ENT <br /> r E Y • <br /> Application Accepted 8 Date Area Employee ID# -pot 4., <br /> Final Inspection By Date 7❑ Ah <br /> PERMIT-Approved by <br /> Character of Soil to pt h t: PlVsump Soil Cha cter: <br /> COMMENTS P <br /> n b-ftr <br /> AIA <br /> 2sL90S <br /> PE Sc Received Checialff Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remi Service Request# <br /> • '54Z 02A LU <br /> 42-01 /� '/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 6P` � <br />