Laserfiche WebLink
V . <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E.HAZELTON AVENUE-STOCKTON CA 95295-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 49 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 12080 E.Acampo Road CITYI7JP Lodi,CA 95220 y <br /> CROSS STREET Elliott Road APN 017-270-12 PARCEL SIzE 16.41 <br /> OWNER NAME Jeremy Trettivik PHONE 209-367-3773 <br /> OWNER ADDRESS 6 W.Pine Street CITYISTATEIZIP Lodi,CA 95240 <br /> CONTRACTOR TERRACON CONSULTANTS INC. PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYlSTATE2JP LODI CA 95240 <br /> LICENSE DEC-42 DCC-36 OTHER C-57 NUMBER 669004 ExPIRAnoN DATE 5/31/19 <br /> WATER TABLE DEPTH: <100 R GEOGRAPHICAL INFORMATION: Coordinate! X Y <br /> PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION C REPAIR/ADDITION r I ENGINEER DESIGNED/ALTERNATIVE <br /> I� REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM r 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 SUE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES J LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION it PROPERTY LINE ry <br /> ❑ FILTER BED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH R DEPT ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ry <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft 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 /> MMUM 48 HOUR ADVANCE NQ=REQUIRED FOR INSPECTIONS-PL98SE CALL(209)953-7697 <br /> SIGNED TITLE STAFF SCIENTISTSol <br /> DATE 04/04/2019 <br /> IN SEEN I I I I I I <br /> ENE <br /> T <br /> NNONE NET <br /> IEEE= 11111 <br /> 0 J}. <br /> �r <br /> .0 <br /> DEPARTMENT US&ONLY <br /> Application Accepted By �� Date Area_��u / Employee ID#� � <br /> Final Inspection By Date ❑ SPEC PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received ,Checkl1W Amount Date Permit/ Invoice# Permit[DO <br /> Code INFO By as Remitted Service Request# <br /> 1229712 �� <br />