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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 U <br /> t* <br /> CROSS STREET Elliott Road ApN 017-270-12 PARCEL SIZE 16.41 0 <br /> C <br /> OWNER NAME Jeremy Trettivik PHONE 209-367-3773 <br /> v. <br /> OWNER ADDRESS 6 W. Pine Street 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 C-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 # 1 BUILDING PERMIT# LAND USE APPLICATION# <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 /> MINIM 48 HOUR ADVANCE NOT CE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED I + C L�� TITLE STAFF SCIENTIST DATE 04/04/2019 <br /> , f <br /> IY <br /> Ir <br /> DEPARTMENT USE ONLY <br /> Application Accepted By. Date Area Employee ID#� <br /> Final Inspection By t61c.-�— Date — C SPEC L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: "Pitdump Soil Cha acter: <br /> COMMENTS x& z-SYICU�-/ <br /> PE SC Receivedec Amount Date Permit Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Re ue t# <br />