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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 11250 N. Micke Grove CITY/ZIP Lodi, CA 95240 <br />CROSS STREET Eight Mile Road /'? e rr --APIN 1. 0/59-140-57 PARCEL SIZE 10.0 AC <br />1. <br />OWNER NAME Mario Carrasco — Sc, p D�11 ye C f F `-• PHONE 209'4635395 <br />OWNER ADDRESS 5252 E. Bear Creek Road CITYISTATE/ZIP Lodi, CA 95240 <br />CONTRACTOR Dillon & Murphy c/o Joe Murphy PHONE 209-334-6613 <br />CONTRACTOR ADDRESS PO Box 2180 CITYISTATE/ZIP Lodi, CA 95241 <br />LICENSE I C-42 . C-36 OTHER RCE NUMBER 45277 EXPIRATION DATE 09-30-2022 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: CdordlnateS X <br />Y <br />PS PERC TEST # 2 <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />ft PROPERTY LINE ft <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />I COMMERCIAL <br />I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />Permit/Invoice <br />LENGTH OF LINES ft <br />B Cash <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />1 q 3 <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />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 />RF YMFNT <br />cF�vFo <br />-` I'� 02 <br />v w JOAQU/ A21Area C L Employee ID# rH FPART PAL ry <br />SPECIAL PERMIT - Approved by MENr <br />PE SC <br />Received LChec l <br />Amount <br />Permit/Invoice <br />Code INFO <br />B Cash <br />Remitted <br />Date # Permit ID# <br />ice Re u st # <br />.aa <br />1 q 3 <br />PzoY <br />0 0 KLA Oft <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />