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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-KEFUNDABLE PERMIT L:ALL (LU&) .V03-/09! FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS 15780 N CLEMENTS RD CITY21P LODI, 95240 CROSS STREET KETTLEMAN LN APN 053-190-010 PARCEL SIZE 150.86 AC OWNER NAME SAMMY COX PHONE (916) 416-5236 OWNER ADDRESS PO BOX 1592 CITY/STATE/ZIP LINDEN, CA. 95236 CONTRACTOR DILLON & MURPHY PHONE (209) 3346613 CONTRACTOR ADDRESS 647 N. CLUFF AVENUE, SUITE A-2 CITYISTATE/ZIP LODI, CA. 95240 LICENSE 11: -IC -42 11436 OTHER R.C.E. NUMBER 45277 EXPIRATION DATE 9-30-22 WATER TABLE DEPTH: 150 It GEOGRAPHICAL INFORMATION: Coordinates X Y R PERC TEST # 2 BUILDING PERMIT # LAND USE APPLICATION #PA -2200052 TYPE OF WORK: Fi NEW INSTALLATION F7 REPAIR/ADDITION Fl ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -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 It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft 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. Mk11►MUM 4R HOUR AnvANrFwr)T►CF RFn1nRFn FAR 111LCPFCT►nNC - Pt FASF cal 1 191101 00;4-7907 SIGNED Application Accepted By Final Inspection By Character of Soil to Depth 43 COMMENTS 'a DSC. 'i y -i' 15 o�.l ( t 1, 1,24 14-0 /x PERG TE6T] ARTME TU ONLY Date Area L Date SPE Pit/Sump Soil Character: 61 DATE r -2 %-Z ?-- WENT :CEIVED N 2 7 2022 ,AOUIN COUNTY DEPARTMENT Employee ID#l�r== PERMIT - Approved by PE SC Received Check#/ Amount Permit/ Code INFO Castf LRemitted,Date Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18