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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 ADDRESS 6237 E HARNEY LANE CITY2IP LODI 95240 rn CROSS STREET CURRY AVE APN J6 0 S J / PARCEL SIZE OWNER NAME ERNESTO MEDINA PHONE J L OWNER ADDRESS '?\ - CITY/STATEIZJP CONTRACTOR WEST COAST BACKHOE,INC. PHONE 209-339-7394 CONTRACTOR ADDRESS 33 MAXWELL STREET CrrY/STATE/ZTP LODI,CA 95240 LICENSE ❑ C-42 ^_C-36 OTHER A NUMBER 851157 EXPIRATION DATE 2023 7 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# F TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED IALTERNA i4 REPLACEMENTc OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION ` INSTALLATION WILL SERVE: F RESIDENCE C COMMERCIAL ❑ OTHER f NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG r't- CAPACITY gal #OF COMPARTMENTS :JL \ ❑ 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) IIs LEACH LINES LEACHING CHAMBERS #OF LINES 1 LENGTH OF LINES 42' it DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Y SEEPAGE PITS NUMBER 1 WIDTH 36' ft DEPTH 25' ft DISTANCE TO NEAREST WELL 95' ft FOUNDATION ft PROPERTY LINE ft 1 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. MI48 HOUR ADVANCEE REQUIRED FOR INSPECTIONS -P 1 SIGNED CLTITLE P'f<J1 �oCC�(nttk�l;.,'DATE G Z-C) L (n_< V Z Z � rnZ ZC � r0 PAY !_' REC � Z AUG c rj Z SAN:+OAO A Eth'4IRO SILT- HEALTH s DEPARTMENZ-USE ONLY Application Accepted ByL 1 Date 71 Area Employee ID# --I Final Inspection By iV6eew", iYL�/!/1� Date 9-' � SPECIAL PERMIT-Approved by [� Character of Soil to Depth of 3 Ft: Pit/Sump Soil Cfharfcter. COMMENTS ul Pl ' , �Xlstl%� 1'C I / e S In 1 fF'ir TIr-;x Ae,;'1l PE SC Received Check#/ Amount Date Permit/ Invoice# PermitlD# Code INFO Cash Remitted Service Re uest# 42-01 � ll3,Z7O[� 0, - ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 44/14/18