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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AvENuE-STOCKTON CA95205-(209)468-WO <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Job ADDRESS <br /> 5484 W.HIGHWAY 12 CITY21P LODI,CA 95242 <br /> M <br /> CROSS STREET <br /> FLAG CITY BLVD APN OSS-16D-23 PARCEL SIZE 10-78 g <br /> p <br /> P <br /> OWNER NAME TONY ALEGRE PHONE 209-200-2103 <br /> OWNER ADDRESS 49W W.HIGHWAY 12 CrY/STATFJZp LODI.CA 95242 <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209367'3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY C.ITYISTATE/ZJP LODI,CA 95240 <br /> LICENSE ❑ C.42 EllIC-36 OTHERC-57 NUMBER 659004 ExPIRAnoN DATE 5/31119 <br /> WATER TABLE DEPTH: 14 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPUCATION# <br /> TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DE&GNEo 1ALTERNATIVE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRucnoN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL _ OTHER <br /> NUMBER OF LrvING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ UFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIOTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTYLINE R <br /> ❑ SEEPAGEPITS NUMBER worm ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILLBE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> A'1 'I ifi;J UQUR AQVANQE NO E REQUIR O FOR INSPECTIONS-PLEASE GALL(209)953-7697 <br /> SIGNED TITLE STAFF SCIENTIST DATE JANUARY 18,2019 <br /> W.MGHNAY 12 <br /> $100 W.HIGHWAY 12 <br /> D ARTMENT S N Y <br /> Applicatlon Accepted 8 Date Area Employee ID# <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIUSump Soil Character. <br /> COMMENTS <br /> PE SC Received ec Amount Date Penn Ml Invoice# Permit IDN <br /> Code INFO — a-SF Remitt Servic ues[# <br /> 7j 2-2,� <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 4114118 <br />