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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 122 WeSI Harney Lane CITY/ZIP LOdt,95242 <br /> CROSS STREET North Extension RoatlqpN G�d.r r'C_'I��,� PARCEL SIZE 2701 acres T <br /> c <br /> PHONE <br /> OWNER NAME <br /> Hsin Orchids (209)602-6569 R <br /> OWNER ADDRESS 122 Wesl Harney Lanz CITY/STATE/ZIP Lodi.CA 95242 <br /> CONTRACTOR Baez Gectechnical Group PHONE (209)632-3779 <br /> CONTRACTOR ADDRESS 2060 Colorado Avenue.Suite B CITY/STATE/ZIP Turlock,CA 95382 <br /> LICENSE _.! C42 0- C36 OTHER GE 2339/CE 43010 NUMBER EXPIRATION DATE 3/31/2022 <br /> WATER TABLE DEPTH: 4' N GEOGRAPHICAL INFORMATION: Coordinates X 38 099161 Y 121 31cc"2 <br /> Q 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: RESIDENCE -Y COMMERCIAL - - OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:UP 10 50 <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES C LEACHING CHAMBERS_ #OFLINES_ LENGTHOFLINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 HO R ADVANCE IR FOR INSPECTIONSACALL(209)953-769 <br /> SIGNED TITLE Project Engnlaer DATE i 20,2023 <br /> E v <br /> Nr <br /> ED <br /> 2 8 2020 <br /> UIN COUNTY <br /> E ARTT <br /> AL <br /> MENTI <br /> DEPARTMENT US ONLY L► r� <br /> Application Accepted By� L"L� Data7/.171,1 0 Area l Cf�I Employee ID# <br /> Final Inspection By Date - SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS R'FC 0 <br /> PE SC Received Check#/ Amount Date Pem11U Invoice# Permit ID# <br /> Code INFO B <br /> Ai Cash Remitted Service Re ue # <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114,18 <br />