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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENARONNIENTAL HEALTH DEPARTMENT 1869 E.HAIELTON AVENUE-STOC KTON CA 95205•(209)4 68-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-769 7 FOR 11YSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 5484 West ST.RT.12 Hwy CrTyl2p Lodi 95241 v <br /> w <br /> rr <br /> CROSS STREET N.Flag City Blvd, APN U f b� PARCEL SIZE <br /> tl <br /> OWNER NAMEAIegnn Trucking <br /> PHDN€ <br /> OWNER ADDRE55 5484 W,ST.RT.12 CITYISTATE6LP LODI 95241 <br /> CONTRACTOR Haley Contracting p,,,,20946&2517 <br /> CONTRACTOR ADDRESS 4228 Newton Road CrryrSTATEITp Stockton,CA 95205 <br /> LICENSE C-42 C-36 UTHEn A NUMBER 580967 EXPIRATION DATE 1113012021 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMrT#F `- LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTAL LATH REPAIR!ADDmoN ENGINEER DESIGNED(ALTER NAT NE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL 5ERVE: RESIDENCE h CoMwERcIAL OTHER <br /> NUMBER OF LIVING UNITS: J NUMBER OF BEDROOMS: n/�� NUMBER OF EMPLOYEES: I■ [A�+ .�}t S <br /> .�' SEPTIC TANK Tl'PE!MFG LL.. rY. CAPACITY )-60 gal 40FCOMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION It PROPERTY LME It <br /> CI LIFT STATm S17E TYPE OF PUMP`S 0 PKG Tit PLANT (3 SAND OIL SEPARATOR IEINC LOSED SYSTEM) <br /> LEACH LINES )( LEACHING CHAMBERS � `� � #OF LINES LENGTH OF LINES r ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION�3ft PROPERTYUNE R <br /> Q FILTER BED w{DTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LANE ft <br /> ❑ 5UMP5 WIDTH R LENGTH R DEPTH fi <br /> DISTANCE TO NEAREST WELL ft FOUNRATION It PROPERTY LINE ft <br /> Q DISPOSAL PONDS WIaTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL k FOUNDATION ft PROPERTY LINE ft <br /> Ll SEEPAGE PITS NUMBER W>mN ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> f HEREBY CERTIFY THAT L HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE OOHE IN ACCORDANCE WITH SAN JOAOU IN COUNTY ORDINANCES, <br /> STATE LAWS AN RULES AND REGULATIONS OF SAN JO AOU IN COUNTY. <br /> FOR IT! N - )�•{ -777r6�9y g� <br /> SIGNE <br /> TIT L DATE-i^'�[eCT1tiC I <br /> Rr�F <br /> F�F�yNr <br /> 9u 24900 <br /> copN <br /> MFNT <br /> DEPARTMENZ USE OHL r J)/A Application Accap y Data da x7020 Area Employee ID# YH <br /> Final Inspection By Data �1'06 �-LVV,3 SPECIAL PERMIJ,•Approved by <br /> Character of Soii to Depth of 3 Ft: PWSump Soil Character; ` <br /> COMMENTS vJ ❑Im)Oef 41Ci s 5 mm P II Is utiflc F l I c mum m SO i 1 <br /> uer ove( h t7 5 Sb141; IncY1P5r 1G IIf1�1i'1 TZt o� �rPa7Lh 5 ctll be <br /> PE Sc Re"lVed Amount Dow Permit! Ripe N Permit 111130 <br /> Code INFO vVL Cash Remitted Service Request S <br /> �aa� ase - zz ���o •�t•� s va <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114116 <br />