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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E- HAI-ELTON AVENUE - STOCKTON CA 95205 - (209) 488-9420 NON-REFUNDABLE PERMIT _-- CALL20-� 9 953- 7697FOR INS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 15780 N Cl EMENTS RD ----- Ctiy7LP LODI, 95240 CROSS STREET KETTLEMAN LN ---- -- _ APN 053-19D-010 PARCEL SIZE 150.86 AC OWNER NAME SAMMY COX OWNER ADDRESS PO BOX 1592 ----__-PHONE (9 18) 418_5238--__— LINDEN,CA.95236 CONTRACTOR DILI.ON 6 MURPHY PHONE (209) 334-6813 CONTRACTOR ADDRESS 847 N. CLUFF AVENUE, SUITE A-2 -------.— Cny/STATEILP LODI. CA. 95240 LICENSE UI IC -42 UI ICJ6 OTHER R.C.E. NUMBER 45277 9- EXPIRATION DATE 30-22 WATER TABLE DEPTH: 150 9 PERC TEST # It GEOGRAPHICAL INFORMATION: COOrdinale3 X LAND USE APPLICATION N REPAIR/ADDITION Y A-2200052 _ --j _ fJ REPLACEMENT - rl ENGINEER UESIGNED/ALTERNATNE LI OUT -0F -SERVICE SEPTIC SYSTEM INSTALLATION WILL SERVE: ❑ RESIDENCE --------------------- IJ DESTRUCTION NUMBER OF LNG ONITS: M U COMMERCIAL� -- �) 1 - --- NUMBER OF BEDROOMS: NUMBER EMPLAYEE3: 13 SEPTIC SEPTIC TANK TYPE/MFG __ ❑ GREASE TRAP TYPEIMFG - CAPACITY --- Will # OF COMPARTMENTS- -___ CAPACITY gal III OF COMPARTMENTS- --__ DISTANCE TO NEAREST. WELL ft FOIADItT1ON L) LIFTSTATION SIZE TYPE OF PUMP LJ PKG TX PLANT ❑ SAND OIL SEPARATOR _ it PROPERTY LINE (ENCLOSED SY--STEM)-- It ❑ LEACH LINES II LEACHING CHAMBERS - - — # OF UN[s LENGTH OF LINESIL DISTANCE TO NEAREST WELL R FOUNDATION -----fl _ ❑ FILTER BED WIDTH it LENGTH PROPERTY UNE PROPERTYfl IL DISTANCE To NEAREST WED.— - ft fO�`noL'1 Du rH fl CJMOUNDED WIDTIi R LENGTH fl PROPERTY DNF. It _ _ DISTANCE TO NEAREST WELL - ft FOUNDATION-- rt DEPT„ ft ❑ SUMPS WIDTH ft LENGTH - _._.ft PROPERTY LINE It _ DISTANCE TO NEAREST WELLR FOUNDATION R DEPTH ------ — fl ❑ DISPOSAL PONDS YIIIDTH ft LENGTFI ft PROPERTY LINE ----- it _ DISTANCE TO NEAREST WELL __II ft FOUNDATION DEPTH it E3SEEPAGE PITS NUMBER WIOTII --_ It PROPERTY LINE it DISTANCE TO NEAREST WELL fl FOUNDATION fl DEPTH it I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION —_ --_ it PROPERTY LINE It AND THE WORK WILL BE DONE7J ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND ` REGULATIONS OF SAN JOAQUIN COUNTY. YMENT .CEIVED N 2 7 2022 DAQUIN COUNTY ARONMENTAL FH DEPARTMENT Application Accepted By _ _ Date Area Employee >tw/ Final Inspection By Date_ Character of Soil to Depth 01`3 Ft: - ---' - O SPECT L PERMIT -Approved by ---PiUSumpSoil Character. COMMENTS ---- -- --- 42-01 4114118 Permit!— Service R uest # Invoice # Permit ID# ONSITE WASTFWATER TRTMNT SYSTEM PERMIT