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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 9490 E.Schmeidt Road CITY/ZIP Lodi/95240 <br /> H <br /> CROSS STREET Bruella Road APN 05111004 PARCEL SIZE 10 ac > <br /> 0 <br /> 0 <br /> OWNER NAME Jeff Nowak PHONE(209)426-5649 <br /> OWNER ADDRESS 320 S.Sacramento Street CITY/STATE/2:1P Lodi/CA/95240 <br /> CONTRACTOR CTE Cal PHONE (209)543-1799 <br /> CONTRACTOR ADDRESS 4230 Kiernan Aveenue Suite 150 CITY/STATE/ZIP Modesto/CA/95356 <br /> LICENSE L1 C-42 U C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 100 ft GEOGRAPHICAL INFORMATION: Coordinates X 38.1524519 Y-121.20039 <br /> ❑ 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: C RESIDENCE L 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES 5 LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 /> SIGNED TITLE Staff Engineer DATE 5/27/2022 <br /> S EIEI JAITIT A C H E D <br /> RrF�MFNr <br /> q y <br /> 3 1 Z� <br /> (RDVIN 7? <br /> C <br /> 074PtV TY <br /> T <br /> PARTMEN. US ONLY <br /> Application Accepted By DateW AreaEmployee ID# <br /> Final Inspection By Date L SPE IAL ERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck#I Amount Permit[Code IINNF-O7 B emitted Dae Service Re uest# Invoice# Permit ID# <br /> 7� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />