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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 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 9263 SCMHIEDT ROAD CITY/ZIP LODI,CA <br /> CROSS STREET BRUELLA APN 051-110-67 PARCEL SIZE 4.25 <br /> OWNER NAME SUZANNE&MARK BETSCHAR� ��ilr � PHONE 209-595-1721 <br /> OWNER ADDRESS 2477 IVORY LANE ��NQ'0�o Z- A J��UITY/STATEILP LODI,CA 95242 <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY ,- �, '-,,I rC'ITY/STATE/Z1P LODI CA95240 <br /> LICENSE 01'C-42 ❑I C•38 OTHER C'S7 NUMBER_�XPIRATIONDATEVI I1-I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> JX PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION p ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ;1 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 TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL__ ft FOUNDATION h PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #DF Lms LENGTH OF LINEs it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LIKE it <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL h FOUNDATION it PROPERTY LINE it <br /> D SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it 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 /> 11 U90 AQYANCE NOT'CE=QUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE STAFF SCIENTIST <br /> DATE 06-20-2019 <br /> /N <br /> t"f FA <br /> Tly <br /> SCHMIEDT ROAD <br /> A T <br /> Application Accepted By Date Area Employee ID#_ � <br /> Final Inspection By Date_ 0 SPE AL PERMIT-Approved by <br /> Character of Soli to Depth of 3 Ft: Plt/Sump Soll Character: <br /> COMMENTS <br /> PE SC Received - hoe Amount Dab Permlt/ <br /> Code INFO Cash Remitted ce Re Asst# Invoice# Permit ION <br /> a2.191sa z :�{ t Servi0� of <br /> 42-01 <br /> 4114118 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />