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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 16510 N.Locust Tree Road f ! b Fi y b CITY/IJP Lodi/95240 <br /> CROSS STREET Victor Road APN 051-120-42&94 PARCEL SIZE 40 AG p <br /> 0 <br /> OWNER NAME Ida Handel PHONE(209)3341675 <br /> Ui <br /> OWNER ADDRESS 16696 N.Locust Tree Road CITY/STATE21P Lodi/Ca/95240 <br /> CONTRACTOR Dillon&Murphy PHONE(209)334-6613 <br /> CONTRACTOR ADDRESS P.O.Box 2180 CITY/STATE/ZIP Lodi/CA 195241 <br /> LICENSE ❑r1C-42 0nC-36 OTHER RCE(Joe Murphy) NUMBER 45277 EXPIRATION DATE 9130/22 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #2 BUILDING PERMIT# LAND USE APPLICATION#PA-2000115 <br /> TYPE OF WORK: fl NEW INSTALLATION Il REPAWADDITION fl ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) *44 <br /> Ell LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES cF�FNr <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE VF® <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �O�O <br /> L1 MOUNDED WIDTH ft LENGTH ft DEPTH �IN <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTHfltQ EpMFNT, ' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ARTMENT <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 /> 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 /> MIN1M E REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNE TITLE Party Chief DATE 10/9/20 <br /> 14 <br /> DIEPA USE ONLY <br /> Application Accepted B Date c, Area/�l Employee ID#�r (% <br /> Final Inspection By Date t 2 I 1'1'2.a7 7.0 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �+G� L 5 Q ` 5• M f� <br /> PE SC Received Chec Amount Permit! Invoice# Permit ID# <br /> Code INFO-�2 B Remitted Service Re uest# <br /> 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />