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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 12080 E.Acampo Road CITY/ZIP Lodi,CA 95220 ti <br /> CROSS STREET Elliott Road APN 017-270-12 PARCEL SIZE 16.41 g <br /> v <br /> OWNER NAME Jeremy Trettivlk (� PHONE 209-367-3773 <br /> OWNER ADDRESS 6 W.Pine Street 2--3(7— X CiTYISTATEMP Lodi,CA 95240 <br /> CONTRACTOR TERRACON CONSULTANTS INC. PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/ZIP LODI CA 95240 <br /> LICENSE 011C-42 DDC-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br /> WATER TABLE DEPTH: "100 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST #2 I BUILDING PERMIT# LAND USE APPLICATION# OU <br /> TYPE OF WORK: r7i NEW INSTALLATION 0 REPAIRIADDITION ❑ ENGINEER DIISIGNED/ALTERNATIVE <br /> n REPLACEMENT Ti OUT-0F-SERVICE SEPTIC SYSTEM L7 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEJMFG 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 U LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE N <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH II DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION III PROPERTY LINE It <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$8 HOUR ADVANCE NOTICE REQURED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGNED TITLE STAFF SCIENTIST DATE 02/27/2019 <br /> N <br /> TY <br /> All <br /> N R N EN A <br /> IT P R UENT <br /> 71 10 <br /> Goosil <br /> Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE Sc Received Check## Amount Date PermlV Invoice# Permit IDN <br /> Code INFO lb Cash Remitted Service Re u s <br /> iq 00 n 7142-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />