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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> *#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 679 W.Turner Rd CITY/ZIP Lodi,95242 <br /> y <br /> CROSS STREET Davis Rd AP 015-050-40 PARCEL SIZE 14.77 C <br /> v <br /> OWNER NAME <br /> JOSeph Dietrich /,Vr- Lw PHONE <br /> OWNER ADDRESS 10086 Creek Trail Circle /D2-1 5' &11(77=_CITY/STATE/ZIP Stockton,CA 95203 <br /> CONTRACTOR Terracon h PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 Indutrial Way CITY/STATE/ZIP Lodi,CA,95240 <br /> LICENSE _ C-42 ❑❑C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5-31-2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #3 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAWADDITION F ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM C DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE C 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 C5JRTIFY 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 4 HOVO 4DVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED i �� TITLE Staff Geologist DATE 2-12-20 <br /> � n <br /> ' <br /> SA14 <br /> N 1'F N<d <br /> pR <br /> c//(��� DEPARTMENT S ONLY <br /> Application Accepted By ibd/ Date Area Employee ID# <br /> Final Inspection By Date -2, — Zvi ❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check# Amount Permit/ <br /> Code INFO B p emitt d Date Service Request# Invoice# Permit ID# <br /> "7 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />