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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 - (209) 4683120 NON-REFUNDABLE PERMIT CALL (209) 9$$-7697 FOR INSPEwimi EXPIRES 1 YEAR FROM DATE ISSLIED JOB ADDRCSS IL111,4 r "E.May 12 Cm.[Zp Lodi/95240 CROSS STREET N Locust Tree St APN 05.112-087 PARCEL SIZE 5-4 OWNER NAME Panny-hriste -_..._.._ PHDNE_ OWNER ADDRESS 1C184 L Hgnway 12 CITY/STATE/7jp LO&CA.95240 CONTRACTOR 'Nes: Coast H nIdets, Inc. PSE 209-339-7394 CONTRAC rUN ADOREss 33 Maxwell St. Cm/STATE2tP LUdi/CA/95240 LICENSE ; C-42 C36 OTHER A NUMBER 651152 EXPIRAnDN DATF 09/30/2023 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordirates X Y PERC TEST #BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION f 1 ❑ REPWiIADGTION - ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 1 G; n k 3 t r CkA D OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION J1 Ci_ j cYf'\iL_ INSTALLATION WILL SERVE: ..1 RESIDENCE COMMERCIAL NUMBER of Lwm UNITS: NUMBER OF BEDROOMS: V` SEPTICTANK TYPWAw PRL OPACITY 1200 ❑ GREASETRAP TYPFJIAFG CAPAGIY _ DISTANCE TO NEAREST: WELL ft FOUNDATION NUMBER OF gal #OPCOUPAP.TIAENTS 2 gal # OF COMPARTMENTS._. It PROPERTY LINE (1 ❑ LIFT STATION 312E TYPE OF PUMP ❑ PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS', Z� # OF LINES _ LENGTH OF LIN_, SS R I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STAIE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. r DEPARTMENT USg ONLY r / Application Accepted By L �� Date /S Area q Cf `� Em ioyee ID# f r �t \ -J Finallnspactio By Date L _ SPECIAL PERMIT - Approved by Character of Soil to Depth A frt: PI"S.-P Sail Character: COMMENTS L1,nr�F: Yl,J1�C� ?,["� �isi� VeFI I-fI"oe'!^ "6Fsr12tlt ET11 e,A;:i r.)t- i,r),jl4b;T PE Code SC INFO DISTANCE TO NEAREST "'ELL lO0 '�- ft FOUNDATION I ti'r `t PROPERT" LINE c7 '1' It ❑ FILTERSED WIDTH It LENGIH it DEPTH R DISTANCE TO NEAREST WR I ft FOUNDATION ft PROPERTY UNE `l ❑ MOUNDED WIDTH Ft LENGTH R DEPTH 1 DISTANCE TO NEAHESI "ELL ft FOUNDATION tt PROPERTY UNE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY UNE fl ❑ DISPOSAI PONDS WIDTH R LENGTH R DEPTH fl DisTANCE TO NCARCST WELL ft ^OUNDATICN It PROPERTY UNE_ _ it 0—SEEPAGE PITS NUMBER .37 WIDTH b ft DEPTH DisTANCE TO NEAREST "ELL I --;V 'r ft=OUNDATICN L10 -t- ft PFCPCR-Y LINE I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STAIE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. r DEPARTMENT USg ONLY r / Application Accepted By L �� Date /S Area q Cf `� Em ioyee ID# f r �t \ -J Finallnspactio By Date L _ SPECIAL PERMIT - Approved by Character of Soil to Depth A frt: PI"S.-P Sail Character: COMMENTS L1,nr�F: Yl,J1�C� ?,["� �isi� VeFI I-fI"oe'!^ "6Fsr12tlt ET11 e,A;:i r.)t- i,r),jl4b;T PE Code SC INFO Received Check#f Amount Cash Remitted Data Permit] Service Re Desi# tnvoiee# Permit IDN I _ 1 '" 3 1 �5 2 S 00 f_��w +ao, 1114116 C'NOTTE WASTEWATER TRTMNT 5YSTEM FERNiT