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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 12080 E.Acampo Road CITY/ZIP Lodi, CA 95220 <br /> rn <br /> CROSS STREET Elliott Road APN 017-270-12 PARCEL SIZE 16.41 0 <br /> O <br /> OWNER NAME Jeremy Trettivik (i PHONE 209-367-3773 <br /> OWNER ADDRESS 6 W. Pine Street / �j3 Z gay lj�eF•CITY/STATE/ZIP Lodi, CA 95240 <br /> CONTRACTOR TERRACON CONSULTANTS INC. PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI CA 95240 <br /> LICENSE C-42 ❑GC-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br /> WATER TABLE DEPTH: <100 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> _ PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION# OV <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697 <br /> SIGNED i' /s�� £Z � �" L� TITLE STAFF SCIENTIST DATE 02/27/2019 <br /> 13 <br /> MhUl <br /> TY <br /> NVR tdN'.ENI'Alj <br /> EAI-T NT <br /> �D PARTMENT V SEO Y <br /> Application Accepted By Date Area Employee ID#tl � <br /> Final Inspection By Date Z2 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIRISump Soil Character: <br /> COMMENTS S&Vt.— 'f'-%+ "rte F31 25-0 ,w�4�i �` r 82. 4Z5--.w .•►cfi <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO V Cash emitted Service Re u s <br /> L2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />