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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SA, 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 Cny/Zlp Lodi,95242 n <br /> r� <br /> CROSS STREET Davis Rd ApN 015-05040 PARCEL S2E 14.77 <br /> ,/ 0 <br /> OWNER NAME Joseph Dietrich /,Y�3 L(jC— PHONE <br /> OWNER ADDRESS 10086 Creek Trail Circle 6 ��� $r/ry/Vq� /� CiTv/STATEIZIP Stockton,CA 95203 <br /> CONTRACTOR Terracon PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 Indutrial Way CITY/STATE/ZIP Lodi,CA,95240 <br /> LICENSE ,]-C-42 UDC-36 OTHER C-57 NUMBER 669004 E%PIRATION DATE 5-31-2021 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION i REPAWADonnoN I� ENGINEER DESIGNED/ALTERNATIVE <br /> .: 'REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: [U RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER IF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG 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 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE To NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE It <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> j STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 4HOuk 4DVAIYCENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 953-7697 <br /> SIGNED \1 �� TITLE Staff Geologist DATE 2-12-20 <br /> t! <br /> A J <br /> IR N <br /> PR <br /> DEPARTMENT S ONLY ] <br /> Application Accepted By Date Area Employee ID#Y-Ft I/1L_ <br /> Final Inspection By Date SPEC AL PIT-Approved by TT�� <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PESC Received Chec Amount Permit/Code INFO By SF emittd Date Service Request# Invoice# Permit ID# <br /> /9 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />