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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT $AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205. (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953=7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 9220 West Highway Highway 12 CITY/ZIP Lodi, CA CROSS STREET Guard Road APN 055-070-21 PARCEL SIZE 5.43 OWNER NAME Steven Ehlers 423-3220 OWNER ADDRESS PO Box 942 LEACH LINES CIN/$TATE /ZIP VICtOr3 CA 95240 # OF LINES LENGTH OF LINES CONTRACTOR Terracon Consultants/Aaron Mejorado PHONE 209-367-3701 DISTANCE CONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/ZIP Lodi/CA/95240 LICENSE ❑�C-42 ❑-C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06/30/2022 WATER TABLE DEPTH: fT GEOGRAPHICAL INFORMATION: 1X PERC TEST # 2 F BUILDING PERMIT # TYPE OF WORK: C NEW INSTALLATION LiREPAIRIADC REPLACEMENT I I OUT -OF -SERVICE INSTALLATION WILL SERVE: L1 RESIDENCE El COMMERCIAL L1 OTHER PTIC SYSTEM DESTRUCTION Coordinates X Y LAND USE APPLICATION # IN ❑ ENGINEER DESIGNED /ALTERNATIVE NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Ll SEPTICTANK TYPE/MFG ❑ GREASETRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFTSTATION SIZE _ _ TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION _ O PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES � LEACHING CHAMBERS Check#/ # OF LINES LENGTH OF LINES ft Invoice # Permit ID# DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953=7697 �� DEPARTMENT US ONLY y `'Li � rn Application Accepted BV A/ �]n Date S" � % Area Employee ID# %F�1� Final Inspection By � ErN- �f�-/�rYLld� Date S/— Za—ZOy/ ❑ SPECIAL PERMIT •Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS R1 Pere6l"icr eaEe 4' 92 P4Fr0t*.ia rcr.tFe PE 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114,18 �1 lz�79 SC Received Check#/ Amount Dae Permit/ Invoice # Permit ID# Code INFO sh Remitted Service Re uest # 7� f