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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 13650 N.Thornton Road CITU/ZIP Lodi,95242 <br /> CROSS STREET Kingdon Road API DS-+' 140-d3 PARCEL SIZE g <br /> O <br /> OWNER NAME Steve COldani PHONE 209-481-6121 <br /> OWNER ADDRESS 13650 N.Thornton Road CITY/STATE/ZIP Lodi,CA.95242 <br /> CONTRACTOR Pacific Construction PHONE 209477-2766 <br /> CONTRACTOR ADDRESS 4523 S.B Street CIN/STATE/ZIP Stockton,CA.95206 <br /> LICENSE - C-42 _1 C-36 OTHER B NUMBER 959669 EXPIRATION DATE 2/26/21 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: i I RESIDENCE J COMMERCIAL I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY ^^ _ gal #OF COMPARTMENTS <br /> GREASE TRAP TVPEIMFG CAPACITY 5pr gal #OF COMPARTMENTS i <br /> ^s DISTANCE TO NEAREST: WELL�3 ft FOUNDATION r12-�~ ft PROPERTY LINE �Ili ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES �r <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH CjP/��� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft VA �ry�o <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH OiAn AI u <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tiE _ 46 CA OUfryrI <br /> Ell DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH Q ARTrAL ,7 <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 /> 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 /> HOUR ADVANCE NOTICE REQUIRED F R I ETI N -PLEASE CALL(209)1pl-7697 <br /> SIGNED TITLE DATE "' jY <br /> U-1_ <br /> c. <br /> i cor ae ewuw to. iwrY caro w <br /> BOLI[e.GS MIO WRP TWt <br /> FF <br /> mw M1Ow'"� � aurp-irE cwm(,e,000 tR) <br /> � cacrrn s,M/ mac�ut wry w <br /> -t- <br /> u <br /> owP%rro <br /> Cyt,- wrt«r <br /> 1 <br /> ',�Ynr ssa <br /> SE INTERCEPTOR DETAIL <br /> •' .i0 SGN.E <br /> FT <br /> DEPARTMENT-USE ONLY <br /> Application Accepted By Date C 6 Area tfL1 Employee ID# DA <br /> Final Inspection By Date -1 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth o Ft: V I j Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cash Remitted Service Request# <br /> 4 A S I ST <br /> 4F'6 b ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/141/14/16 <br />