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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN 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 <br /> 16795 N Jacktone Rd CITY/ZIP Lodi/95240 v, <br /> CROSS STREET Brandt Rd APN� �^ 1 v PARCEL SIZE 2 3 J <br /> O <br /> OWNER NAME Ruben Cortez PHONE 209-271-3300 r��+ <br /> OWNER ADDRESS 16795 N Jacktone Rd CITYISTATE/ZIP Lodi,CA 95240 <br /> CONTRACTOR Stormwater Services PHONE 209-368-3933 <br /> CONTRACTOR ADDRESS PO Boz 569 CITY/STATE/ZIP W1110n,CA OW03 <br /> LICENSE C-42 C-36 OTHER A NUMBER 1012047 EXPIRATION DATE 31"2022 <br /> 38.1351366 212.1514847 <br /> WATER TABLE DEPTH: 'l, ft GEOGRAPHICAL INFORMATION: Coordinates X Y- <br /> F PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG -(Ly�APACITY gal #OF COMPARTMENTS <br /> El GREASE TRAP TYPE/MFG /I,APACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL _ft//t FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTAT10N SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES 1 LENGTH OF LINES 55 ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION.. I O© ft PROPERTY LINE 50 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 It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 1 WIDTH 2 It DEPTH 3 ft <br /> DISTANCE TO NEAREST WELL)8U I,� (i1 It FOUNDATION 1 �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 /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HO X6010E NOTICE RE IRED FOR INSPECTIONS-PLEASE CALL(2 09) -7 7 <br /> SIGNED TITLE RME DATE 7/1612020 <br /> S e e A [ :o a c h e d D r a w i n g <br /> s �Z , 2020 <br /> QIJIN <br /> F;U?41 NAY <br /> ItTITIJ <br /> NT <br /> EPARTMENTUSEONLY <br /> Application Accepted Date I 2Area Employee ID# <br /> Final Inspection By - Date _ zi-Lo SPECIAL PERMIT-Approved by <br /> Character of Soil t Dep of 3 t: Pit/sump Soil Character: <br /> COMME TS '_`�/ <br /> _ cex <br /> O" ` 2-D <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Date Cash Remitted S ice Re uest# Invoice# Permit ID# <br /> r > <br /> 44 {-/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 411 /18 2- 2-2-- <br />