Laserfiche WebLink
14 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAR 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 9263 SCMHIEDT ROAD CITY/ZIP LODI, CA U <br /> y <br /> m <br /> CROSS STREET BRUELLA APN 051-110-67 PARCEL SIZE 4.25 0 <br /> C <br /> OWNER NAME SUZANNE & MARK BETSCHARTd WXdOjZV PHONE 209-595-1721 <br /> OWNER ADDRESS 2477 IVORY LANE �N�f,O�TI��&?'( TY/STATE/ZIP LODI, CA 95242 <br /> CONTRACTOR TERRACON CONSULTANTS INCA[v r PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY r� CITY/STATE/Zip LODI CA 95240 <br /> LICENSE C-42 05C-36 OTHER C-57 NUMBER t �/ EXPIRATION DATE C� I��Ib—1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # 1 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 COMMERCIAL 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 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 ft <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 ft <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 N T E REQUIRED FOR INSPECTIONS - PLEASE CALL 209 -7697 <br /> SIGNED L �j TITLE STAFF SCIENTIST DATE 06-20-2019 <br /> y <br /> . ••::. `,. <br /> OAT <br /> �t:. :�i.:.li•:t.::i 6 <br /> 1, •,':I: •i tl:l <br /> •- IN <br /> O <br /> Im <br /> 1 <br /> �. THD N L <br /> :... • • ::�;. •. N <br /> iii`:?Ir:iailnt i:• • <br /> SCHMIEDT ROAD <br /> E ARTME N T Al SE 40 N L Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By L�' Date _ SPE AL PERMIT-Approved by <br /> Character of Soil te of 3 Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC ReceivedCheck# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />