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� z <br /> 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 9220 West Highway Highway 12 CITY/ZIP Lodi,CA <br /> CROSS STREET Guard Road APN 055-070-21 PARCEL SIZE 5.43 <br /> c <br /> OWNER NAME Steven Ehlers PHONE(209)423-3220 <br /> OWNER ADDRESS PO Box 942 CITY/STATE/ZIP Victor,CA 95240 <br /> CONTRACTOR Terracon Consultants/Aaron Mejorado PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/ZIP Lodi/CA/95240 <br /> LICENSE ❑ C-42 ❑1, C-36 OTHER PE NUMBER 72446 EXPIRATION DATE 06/30/2022 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#PA-2000102(UP) <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE E COMMERCIAL L 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> M <br /> SIGNED Woods-Tamara 'w 3'�.9'„�T—K TITLE Staff Scientist DATE August 18,2021 <br /> e�Io.3 rear eoti <br /> 0.f�a1.3 ieFT sell <br /> e3,ic reel eoe, q y <br /> RF�FMFN�, <br /> q10 2 AFD <br /> �?0 <br /> 04 QUIN ?1 <br /> H�AqR�qONTY <br /> MFNT <br /> do <br /> OL'ie DEPARTMEN NLY <br /> a6i� l(s�1r. Application Accepted By �/Z1- Date a Area e C Employee ID#_F[Z <br /> Final Inspection By 5;f�-'g�'Z-- Date ❑ SPECIAL PERMIT-Approved by <br /> 01J;11�oi 10' Y Character of Soil to Depth of 3 Ft: PiVSump Soil Character: <br /> COMMENTS Per IYlctlar y (/i5 G, -rIY! ejS r' ,t .���I� <br /> e,%r,a*�C y>I- �, Wtf oYef c I '.1G e-4 c a } <br /> pf 1y PE Sc Received Check#/ Amount PermiU <br /> �N Date Invoice# Permit ID# <br /> iS / I ✓AJ Code INFO ash Remitted a Re uest# <br /> J• �S C'Y,.r,,,� a a sa3thS sCIROUS41 13 <br /> C1 V�I, 4121-01 4/18 13 2-2-937 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />