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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 INION-MEFUNDABLE PERMIT GALL tLUYJ YDJ-/OJ/ I•UK 1NSYtGIIUNJ CAYIHICS I T CAM FHVM UAI C IJJUt JOB ADDRESS 4052 Scottsdale Rd CITy/ZIP Lodi 95240 CROSS STREET W/Highway 99 frontage APN 058-120-070 PARCEL SIZE 4.8 ac OWNER NAME Barbara HDecksteadt PHONE 209-224-4227 OWNER ADDRESS 4052 Scottsdale Rd CITY/STATE/ZIP Lodi, CA 95240 CONTRACTOR pwn `' a PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑--C-42 0-C-36 OTHER NUMBER EXPIRATION D WATER TABLE DEPTH: 65 It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # BP 2004358 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE F.. REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER A9 Shop NUMBER OF LIVING UNITS: 0 NUMBER OF BEDROOMS: 0 NUMBER OF EMPLOYEES: 0 ^15 SEPTIC TANK TYPE/MFG P&L CAPACITY 1200 gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) DEPARTMENT USE ONLY Application Accepted By Date 3.73 2 I Area Employee ID#D r ❑ SPECIAL PERMIT - Approved b Final Inspection By D � S-46 Date pp y Character of Soil to Depth of 3 Ft: PIVSump Soil Character: COMMENTS A.6w A6 SIS. f eY .11 PE LEACH LINES 7 LEACHING CHAMBERS # OF LINES 1 LENGTH OF LINES 42 ft Code DISTANCE TO NEAREST WELL 150 It FOUNDATION 10 ft PROPERTY LINE 30 It O FILTER BED WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it ❑ MOUNDED WIDTH it LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH it LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE it O DISPOSAL PONDS WIDTH If LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER' WIDTH 3 ft DEPTH 25 ft DISTANCE TO NEAREST WELL 150 ft FOUNDATION 38 ft PROPERTY LINE 30 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 SIGNED Barbara J. Huecksteadt TITLEowncr DATE 2/25/21 DEPARTMENT USE ONLY Application Accepted By Date 3.73 2 I Area Employee ID#D r ❑ SPECIAL PERMIT - Approved b Final Inspection By D � S-46 Date pp y Character of Soil to Depth of 3 Ft: PIVSump Soil Character: COMMENTS A.6w A6 SIS. f eY .11 PE SC Received Check#/ Amount Permit/ Date Invoice # Permit ID# Code INFO B Cash Remitted S rvice Re uest # 3 117 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 CfiXI Ie/0' ED ?021 00 -Y AL 41E/V7- PE ENr