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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 14953 E.Tokay Colony Road CITY/ZIP Lodi/95240 m m CROSS STREET Tully Road APN 065-080-02 PARCEL SIZE 10 acres > 0 0 OWNER NAME Gene Stoddart PHONE(209)351-0006 m OWNER ADDRESS 14953 E.Tokay Colony Road CITY/STATE/ZJP Lodi/CA/95240 CONTRACTOR Dillon&Murphy PHONE (209)334-6613 CONTRACTOR ADDRESS 847 N.Cluff Ave.,Suite Alt CITYISTATE/ZIP Lodi/Ca/95240 LICENSE ]f1C-42 011C36 Ot.._.- 1 ✓ NUMBER Ll`:)7/J EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST #1 BUILDING PERMIT# LAND USE APPLICATION#PA20oa1o9(MS) TYPE OF WORK: r1 NEW INSTALLATION 'I REPAIRIADDIT10N I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT i.. OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ] RESIDENCE ] COMMERCIAL ] OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM)P ••'L��9��//�/bb O LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE p'1 ft r�VE® ❑ FILTER BED WIDTH ft LENGTH ft DEPTH CC DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE�� J GO ❑ MOUNDED WIDTH ft LENGTH It DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE '/A/co ❑ SUMPS WIDTH ft LENGTH It DEPTH LTN„R m" OvTy DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE RTj, LJDISPOSAL PONDS WIDTH ft LENGTH ft DEPTH n FNT DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE 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. MINIMUM 4 U DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLE SE CALL(209)953-7697 (� SIGNED TITLE /- DATE %— Z/ j DEPARTMENT USE ONLY Application Accepted � L--� Date� ✓�Jo'J Area 1 Employee ID# Final Inspection By Date SPECIAL PERMIT-Approved by Character of Soil to pth of 3 F. Pit/SUmp Soil Chracter: COMMENTS �� D�c .�D h ✓!a SD !?'t:✓7!!l2 GL_ PE SC Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO By- s Remitted Service Re uest# IS- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18