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SU0008786
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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11130
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2600 - Land Use Program
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PA-1100100
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SU0008786
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Entry Properties
Last modified
11/19/2024 1:59:02 PM
Creation date
9/8/2019 12:49:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0008786
PE
2690
FACILITY_NAME
PA-1100100
STREET_NUMBER
11130
Direction
N
STREET_NAME
STATE ROUTE 99
City
LODI
APN
05926058
ENTERED_DATE
6/14/2011 12:00:00 AM
SITE_LOCATION
11130 N HWY 99
RECEIVED_DATE
6/14/2011 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\N\HWY 99\11130\PA-1100100\SU0008786\APPL.PDF \MIGRATIONS\N\HWY 99\11130\PA-1100100\SU0008786\CDD OK.PDF \MIGRATIONS\N\HWY 99\11130\PA-1100100\SU0008786\EH COND.PDF \MIGRATIONS\N\HWY 99\11130\PA-1100100\SU0008786\EH PERM.PDF
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EHD - Public
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f <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTit DLPARTMENT 304 E WEBER AVE-3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-1697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED <br /> JOBADDRESS 11x,4,e9 CITYI"L1P <br /> I <br /> In <br /> CROSS STREET +_`i ApN O '�+LJ O PARCEL SIZE o <br /> OWNER NAME �T t t- PHONE Zi } !j 1- - <br /> OWNERADDRESS CITYISTATFJZIP 1 <br /> CONTRACTOR © PHONE to �• <br /> CONTRACTOR ADDRESS CITYISTATFIZIP <br /> 94, <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE .� <br /> r WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# -� <br /> TYPE OF WORK: ❑ NEW INSTALLATION I3 REPAIR/ADDITION Q ENCINEERDESICNEDIALTERNATIVF. <br /> ❑ REPLACEMENT ❑ DE$FRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES; <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPF/MFG CAPACITY gel 9 O COMPARTMENTS <br /> ❑ PKC TX PLANT DIWANCETO NEAREST: FELL A FOifNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #of LINES LENGTH OF LINES R <br /> DfSTANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE () <br /> ❑ FILTER BET) WIDTH ft LENGTH R DEPTH R <br /> D[SFANCETONEARFSF WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH fl DEPTH <br /> DI STANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE. ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R <br /> -10 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCFTONEAREST WELL__ ft FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQU[N COUNTY. t� <br /> I' MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- LEASE CALL(209)953-7697 <br /> SIGNED TITLE <br /> DATE <br /> ITO <br /> a <br /> 5N <br /> O AL <br /> L <br /> r <br /> ti 1 -4 <br /> L-� I =T-T 9;1 fl <br /> __. _ ..,.... . ...DEPARTMENT SE LY <br /> Application Accepted HY Dale Arca Employee IDN <br /> Final Inspection By - DQ SPECIAL PERMIT-Approved 8y <br /> Character of Soil to Dept 1`317t: PiLfSump Soil Character: <br /> COMMENTS "�ZG _ z - Sic/, tc:' �CrJGi=� t`� <br /> C, <br /> r PE SC Received Check#! Amount Date PermiU Invoice# Permit IDR <br /> i Code [NFO 6 as Remitted Service Renuesi# <br /> 2 1-a ,6 / 79--w0:1,D 4Zpo u 25. <br /> 4212201 <br /> I2122 <br /> Q+zo03 ONSITE WASTEWATER PERMIT <br />
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