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Z Application Accepted By — — <br />Final Inspection By . <br />Character of Soil to Dept." <br />COMMENTS / „MIME 4rOrallgr <br />Code <br />eTSC <br />INFO <br />c; <br />Lre,Lahli <br /> "(et tIztActt.tri t- <br /> <br />Received C eckiti Amount t/ <br />15ili <br />Cash Remitted bate Pe mi <br />Service Re9Luest <br />*iSoR <br />Date r, Area Li /61 c Employee ID# DA p DEPARTMENT11$9,ONLY <br />Date I I I SPECIAL PERMIT - Approved by <br /> PIVSump Soil Character <br />)7,L <br />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 INSPEC77ONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 12172 Hibbard Road cnyizp, Lodi, 95240 <br />Atkinson Road CROSS STREET ApN 063-230-420 PARCEL SIZE 1.18 acres <br />OWNER NAME Pedro Perez — L. fk) r Cerile rk? <br />PHONE 209-642-3171 <br />OWNER ADDRESS Same as above <br />CITY/STATE/ZIP <br />CONTRACTOR PetralOgIX Engineering, Inc. PHONE <br /> 209-770-0731 <br />CONTRACTOR ADDRESS 26675 Bruella Road curyisTATEmp Galt, CA 95632 <br />LICENSE _' C-42 ! C-36 OTHER PG NUMBER 8657 EXPIRATION DATE N/A '1/Z0/93 <br />'r 'J Yit'qvi r'''' <br />WATER TABLE DEPTH: >50 it GEOGRAPHICAL INFORMATION: Coordinates X -121.166003* y 38.089292' <br />LAND USE APPLICATION # PERC TEST # 1 <br /> <br />BUILDING PERMIT # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT ' <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />INSTALLATION WILL SERVE: L RESIDENCE <br />NUMBER OF LIVING UNITS: <br />L COMMERCIAL <br />NUMBER OF BEDROOMS: <br />OTHER <br />NUMBER OF EMPLOYEES: <br />O <br />o <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br />SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES I LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH fl <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI SUMPS WIDTH ft LENGTH ft DEPTH fl <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 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 24 HOUR ADVANC NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE Project Geologist DATE 6/14/2021 <br />A ac <br />42 -01 <br />ONS/TE WASTEWATER TRTMNT SYSTEM PERMIT <br />4,24/12 <br />/ E 21-6 IqD