Laserfiche WebLink
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) 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 12156 Hibbard Road <br />CROSS STREET Atkinson Road <br />OWNER NAME Randall and Carrie Booth <br />Cmt/ZIP Lodi, 95240 <br />APN 063-230-430 PARCEL SIZE 1.73 acres <br />PHDNE 619-922-6899 <br />OWNER ADDRESS Same as above CITY/STATE/ZIP <br />CONTRACTOR Petralogix Engineering, Inc. PHONE 209-770-0731 <br />CONTRACTOR ADDRESS 26675 Bruella Road CITY/STATE21P Galt, CA 95632u <br />LICENSE ❑❑C-42 07C-36 OTHER PG NUMBER 8657 EXPIRATION DATE N/A 0/': <br />WATER TABLE DEPTH: <br />>50 It GEOGRAPHICAL INFORMATION: Coordinates x -121.164700' y 38.089648' <br />❑ PERC TEST # <br />1 BUILDING PERMIT # <br />ft FOUNDATION _ _ <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />❑ NEW INSTALLATION ❑ <br />REPAIR/ADDITION <br />❑ ENGINEER DESIGNED /ALTERNATIVE <br />It FOUNDATION <br />n REPLACEMENT ❑ <br />OUT -OF -SERVICE SEPTIC <br />SYSTEM LI DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTICTANK <br />TYPE/MFG <br />CAPACITY <br />gal #OF COMPARTMENTS <br />❑ GREASETRAP <br />TYPE/MFG <br />CAPACITY <br />gal #OFCOMPARTMENTS <br />it FOUNDATION <br />DISTANCE To NEAREST: WELL <br />ft FOUNDATION <br />It PROPERTYLINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES D LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES _ ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION _ _ <br />It PROPERTY LINE_ _ It <br />O FILTER BED WIDTH ft LENGTH <br />ft <br />DEPTH _ it <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED WIDTH ft LENGTH <br />it <br />DEPTH It <br />DISTANCE To NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE It <br />❑ SUMPS WIDTH it LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />It PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH It LENGTH <br />It <br />DEPTH It <br />DISTANCE TO NEAREST WELL <br />it FOUNDATION <br />It PROPERTY LINE it <br />❑ SEEPAGE PITS NUMBER WIDTH <br />ft <br />DEPTH ft <br />DISTANCE To NEAREST WELL <br />It FOUNDATION <br />It PROPERTY LINE It <br />I I IEREBY 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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED—T–��v� 4-- �"`K_ <br />TITLE Project Geologist <br />DATE 9/20/2022 <br />l DEPARTMENT USE ONLY <br />Application Accepted B — !✓=� Date Cj Area Employee[D# FirC�N <br />Final Inspection By Date 1 Z❑ SPECIAL PERMIT -Approved by <br />Character of Soil to De%'t of Ft: PIUSump SolI Character: <br />p <br />COMMENTS k6]A 21 U -CL TK Cow,,���SS� �o IA'L— t <br />PE SC Received Check#/ Amount Date Parm iU Invoice # Permit 10# <br />INFO I e uestCode <br />qd <br />aa sa 3 1 �G <br />4/24/ /t) 0 I / S q / � / ' A' �� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 (�/ (� JJJ L/ / �/(/ <br />122 <br />TY <br />NT <br />