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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 10969 E State Route Highway 12 Cr y2s, Lodi,95240 y <br /> CROSS STREET N Tretheway Road APN 051-150-61 PARCEL SIZE 9.32 0 <br /> OWNER NAME Maria De Jesus Ramirez PHONE 209-208-4022 <br /> OWNER ADDRESS 10380 E Kettleman Lane CITY/STATE21P Lodi,CA 95240 <br /> CONTRACTOR Petralogix Engineering,Inc PHONE 209-770-0731 <br /> CONTRACTOR ADDRESS 26675 Bruella Road CITY/STATFJLP Galt,CA 95632 <br /> LICENSE ❑ IC-42 ❑ �C-36 OTHER PG NUMBER 8657 EXPIRATION DATE N/A <br /> WATER TABLE DEPTH: >30 R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 19 PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: i NEW INSTALLATION REPAIRJADDn ION '1 ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM I 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 931 #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLR FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYLINE ft <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R <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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED S / TITLE Project Geologist DATE 4/28/2021 <br /> E FNT <br /> c �AFD <br /> JZ A <br /> 28202, <br /> NARV 74L Y <br /> NT <br /> A R T M E IV T JJA E 0 L <br /> Application Accepted By DateArea 'fal Employee ID# <br /> Final Inspection By Date 1. D SP CAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: k a PIUSump Soil Character. <br /> COMMENTS k74- <br /> PE SC Received Check#/ Amount ata Permit/ Invoice# Permit ID# <br /> Code INFO B Ca h RemittedService uest# <br /> S <br /> 42-01 ONSITE WASTEWATER TRTMHT SYSTEM PERMIT <br /> 4/24/12 <br />