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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT tr RECEIVED <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 r� Q <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEDAy 1 ? 018 <br />JOB ADDRESS 6805 East Harney Lane CITY/ZIP Lodi, CA 95240 - w <br />3!J p N <br />CROSS STREET Vintage Road APN " i� 5 PARCEL SIZE ' �-5E R mNMENTAL H <br />OWNER NAME James E. Thompson PHONE 3103087414 E IPSER OI✓ES <br />-TH <br />OWNER ADDRESS 857 Hillwood Drive CITY/STATE/ZIP Marietta, GA 30068 lIC <br />CONTRACTOR PHONE' <br />CONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />LICENSE I I C-42 LI <br />C-36 OTHER NUMBER E%PIRATION DATE <br />WATER TABLE DEPTH: <br />It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />_I PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Yes <br />INSTALLATION WILL SERVE: '._1 RESIDENCE COMMERCIAL _ OTHER <br />NUMBER OF LIVING <br />UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />It <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS # OF LINES LENGTH OF LINES <br />it <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH it DEPTH <br />it <br />DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH It DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH it DEPTH <br />it <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE <br />ft <br />1 HEREBY CERTIFY THAT <br />I HAVE PREPARED THIS AP AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STAT WS AND 911ULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />U <br />R FOR INSPECTIONS - PLLEASE CALL 209 953-769 7 <br />SIGNED <br />/ `ICE �REQUIRED <br />53 (� <br />NL/YYIi/8Lf7� TITLE e &-) Xf � AL— DATE �] V q/lI <br />PA <br />MAY 21 <br />SP AQUIN <br />E� RONM <br />HEATH DEP' <br />Application Accepted <br />Final Inspection By_ <br />Character of Soil to D <br />COMMENTS --f <br />Date ( Area _�` _"_/ L PE14 Employee by <br />Date <br />,I/ SPEC AL PERMIT -Approved by <br />3 F : PI um Soil haracter: <br />U <br />PE SC <br />Code INFO <br />Received Check#1 Amount Perm*" <br />s emitted Date Service leguest # Invoice # Permit ID# <br />J u <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14118 <br />