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' LJ <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAIELTON AVENUE-STOCKTON CA 95205.(209)40-MO <br /> NON-REFUNDABLE PERMIT CALL(209)953-M7FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREaa_22420 N Highway 99 w Fm,�A Qr nYzP Acam❑o. CA 95220 <br /> CROSS STREET_Peltier ASN 013-190-05 PMCELSm, 3.59ACRES > <br /> OWNER NAME_ <br /> t4i2ebedo-6arrW Sw� VOAlj £%tLggc"d D1i 209-810-4677 <br /> /• OHE <br /> OWNER AODREae =2063-Providence-Wag `1�OW / �R;.;S�, P Lodi, CA 95240 <br /> CONTRACTOR <br /> TERR�iV-EONSWTANTS-Hd$„'�„E'I °A•�l« .1209-367-3701 <br /> CDxTMCroR AooREBE 902 INDUSTRIAL WAY CIr USTATE LODI, CA 95240 <br /> LICENSE ❑ C42 [) C-38 Onnot C57 NUMSER669004 EXPIRATION DATE 5/31/2019 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: COortllnatM X Y <br /> PERC ST R_1 L BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WOTERK: NEW INSTALLATION REpAIRIAoomON ENGINEER OESIOIEO/ALTERNATIVE <br /> REPLACEMENT OUT-OF SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESMENCE COMMERCIAL 0 OTHER <br /> NUMBEROFLIVIRGUHRS: NUMSEROFBEDROOMS: NUMBER OFEMpLOYEES: <br /> ❑ SEPTICTANK TYPE/MPG CAPACITY pal NOFCOMARTMENrs <br /> ❑ GREASETRAP TYPE/MFG CAPACITY pal NOFCOMPMT.EKTS <br /> DISTANCE To NEAREST: WELL it FOUNDATION X PROPERIYLINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKO TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHINGCHAMBERS #OFL,Ks LENGTHOFUNEa B <br /> DsTANCE To NEAREST WELL R FOUNDATION—ft PROPERTYLINE R <br /> ❑ FILTER BED WIDTH R LENGTH fl DEPTN it <br /> DISTAHOE TO NEAREST WELLR FOUNDATION N PROPERTYLOE R <br /> ❑ MOUNDED WIDTH R LENGTH N DEPTH N <br /> D*TANCE TO NEMEaT WELL S FOUNDATION it PROPERTYLWE B <br /> ❑ SUMPS WIDTH R LENGTH B DEPTH R <br /> DISTANCE TO NEAREST WELL it F-0UNDATGN S PROpERTVUNE K <br /> ❑ DISPOSAL PONDS WIDTH K LENGTH it DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION h PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH h DEPTH it <br /> O6TANCETo NEAREST WELL K FOUNDATION h PRONERTYLINE B <br /> 1 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE STAFFSCIENTIST DATE 03-01-2017 <br /> i''�''� _ PROPOSED LEACH <br /> q — —PELTIERROAD = FIELD <br /> N <br /> 17 <br /> 1 AL <br /> is RjA <br /> ENT, <br /> ■ <br /> Application Accepted By *PI <br /> Alla Employee IDS <br /> Final Inspection By 0 SP IAL ERMIT-Approvedby <br /> Character of Sall to Depth of 3 Ft: Chander: <br /> COMMENTS .SIAE 6 STOE TS a( D_FTq 2S FT 6E I (: Do.0As <br /> - -LL.6d Na Lia -.ERC-rE T 2Sf Ascom 1 04-7 nRN I�Jc <br /> PE SC ReceNed ChxMl/ Amount Data PsmNU InvoiceR Pem4t IDN <br /> Coda INFO B CBSh RemNtetl SeMrsR uBHN <br /> 7 <br /> 63-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4MQ12 <br />