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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 2125 S.Lower Sacramento CITY/LP Lodi 95242 v, <br /> 2(� :j <br /> CROSS STREET Century Blvd APN 058-040-010 PARCEL SIZE J I• V o <br /> v <br /> OWNER NAME FCB Homes PHONE 209-957-8112 <br /> OWNER ADDRESS 10100 Trinity Parkway#420 CITYISTATE/ZIP Stockton,Ca 95219 <br /> CONTRACTOR Modesto Sand and Gravel PHONE 209-545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett Court CITY/STATE/ZIP Modesto,Ca 95358 <br /> LICENSE I, C-42 IJ_C36 OTHER C21 NUMBER 271166 EXPIRATION DATE 02/28/2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I PERC TEST # j I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _ REPAIRIADDITION ENGINEER DESIG ED/A4TERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM W/ DESTRUCTION C <br /> INSTALLATION WILL SERVE: I RESIDENCE F COMMERCIAL L' OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal A OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES i LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> .�I STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. �J�� <br /> 48 HOUR AQVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGNED t'I/ TITLET�af m� � DATE 'Z- Z7 <br /> VFD <br /> 0220 <br /> T MJ/tFtiTA�N�Y <br /> RT)yENT <br /> T DEPARTMENTU EONLY <br /> Application Accepted By G 1 Date 7 JU�O Area `oI Employee ID# L)A <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth 6f 3 Ft: /PI6Sum6 Soil Character: <br /> COMMENTS t,01L f`C,i Res-dfllce b1in ;.:I odl1 hec.L 0)(711 1 J <br /> GI 1 V hm,iS rJuwnL- �t/IV�`Ekb6� �d�n€�L-� - l" - r"-w *' ix XA4'=V <br /> 1164' 6a"Ifell't, <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted rvice R uest# <br /> as o7� S S�' ti <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />