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t <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 22420 N. Highway 99 to \ t�l ne F-C m2m AcamDo. CA-U221- <br /> CROSS <br /> A95220CROSS STREET Peltier APN 013-190-05PARCEL SIZE 3.59ACRES <br /> OWNER NAME <br /> - berto-Gamma' -�JLL, 4LA*110,j_�fAlrl HONE 209-810-4677 <br /> OWNER ADDRESS —2063 ProvidenCe-WSY "17"a I,"XCrrY ISTrATE`ra, Lodi, CA 95240 <br /> CONTRACTOR <br /> TEERAflid�ONUL�AidT,-5-lide o E'� °Ark�t-x ;209-367-3701 <br /> CONTRACTOR ADORESE 902 INDUSTRIAL WAY—CITY/STATE/ZIP LODI, CA 95240 <br /> LICENSE C-42 C-36 OTHER C57 NUMBER669004 E%PIRATION DATE 5/31/2019 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST #_�., I BUILDING PERMIT# LAND USE APPLICATION# b <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE X COMMERCIAL l OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS __ <br /> DISTANCE TO NEAREST: WELL it FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL III FOUNDATION It PROPERTY LINE R <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH h <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTYLINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH If DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYLINE it <br /> ❑ sumps WIDTH R LENGTH It DEPTH fl <br /> DISTANCE TO NEAREST WELL It FOUNDATION If PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE it <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED "Cla (I&I, TITLE STAFF SCIENTIST DATE-03-01-2017 <br /> PROPOSED LEACH <br /> — —PELTIERROAD = FIELD <br /> N <br /> I <br /> WO-- I <br /> TM <br /> EN SE <br /> Application Accepted By /Data Area Employee IDN <br /> Final Inspection By Date ❑ SPE IAL RIAIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PI mp Soli Character: <br /> COMMENTS f�IA,E b S,OE TS }1 1FT 2-5 F7 1 / t I DaA-ribAS- <br /> LL>E.d Ala bLo 1 T�/�C TEST T 2S f itSf-D I 1 if--j nL&JI IJ c <br /> PE Sc Received Check#I Amount Date Permit/ Invoice# PermitlD# <br /> Code INFO B Cash Remitted Service R uest t$ <br /> 2Z 1 <br /> C_ <br /> 42-DI ONSFTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4,124i 12 <br />