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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAID JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 E.HALELTON AVENUE-STOCKTON CA 552"-(209)468,1420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EMRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 16221 E.Baker Rd. aTymp linden 95236 m <br /> CROSSSTREET Tully APN 091-090-27 pARcEj SaE39-84Ac. d <br /> 0 <br /> OWNER NAME Jeanne Zolezzi PHONE(2 )472-T700 eye <br /> OWNER ADDRESS 16323 E.Baker Rd. CITy1STATEmp Linden,CA 952M <br /> CONTRACTOR Use Oak G eoEnA ronmental PHONE(209)369-0375 <br /> CONTRACTOR ADDRESS. 407 W.Oak St CITYISTATFJPIp Lodi,CA 95240 <br /> LrCENSE ❑❑C42 ❑OC-36 OTHERCEG NUMBER 2151 ExPIRA-noN DATE 413MB <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST IC BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C New INSTALLATION E R/�E,P�AWADDrnoN - ENGINEER DESIGNED(ALTERNATIVE <br /> C REPLACEMENT C OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: Cl RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 13 SEPTICTANK TYPNMFG CAPACITY <br /> ]al E CIF COMPARTMENTS <br /> 0 GREASE TRAP TYPEIMFG CAPACITY gal E OF COMPARTMENTS <br /> DISTANCE TO NEAREST. WELL It FOUNQA_nQk ft PROPERTY LINE ft <br /> CI LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT Ll SAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> ❑ LEACH LINES 11 LEACHING CHAMBERS S OF LINES LENGTHOF LINES ft <br /> DisTAmcE To NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WioTH ft LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH tt <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH R <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST W ELL It FOUNDATION It PROPERTY LINE It <br /> CI SEEPAGE PITS NUMBER I WOTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> [HEREBY CERTIFY THAT I HAVE PREPARED THS APPLICATION AND THE WORM(WILL BE DONE IN ACCORDANCE 11NTH SAN JOAQWN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAWIN COUNTY_ <br /> MfNIM NOTICE REQUIRED FOR INSPEC77ONS-PLEASE CALL <br /> SIGNED TITLE Project Manager DATE <br /> r <br /> ❑EPt1RTAI NTU E LY <br /> Application Accepted By_l�'/T� �„ Date Area I90 Employee ID#_j!f� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth Of 3 Ft_ PitGumP Sal Character. <br /> COMMENTS <br /> PE SC Received bee Amount �� Permit! Invoice# Permit IDp <br /> Code INFO B ash Remitted Service R uestp <br /> a 3 r �.5 <br /> 42-01 ONSRE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4111118 <br />