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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 11560 West Clover Road CITYIZIP Tracy,95304 <br /> n <br /> CROSS STREET Corral Hollow Road .�APN 212-260-220 PARCEL SIZE 1.16 > <br /> OWNER NAME Vanessa&Vigo Pina �01 6��(�f PHONE 209 640-4909 m <br /> OWNER ADDRESS 11560 West Clover Road / kms' CITY/STATE/ZIP Tracy,CA.95304 <br /> CONTRACTOR Advanced GeoEnvironmental,Inc(AGE) PHONE(600)511-9300 <br /> CONTRACTOR ADDRESS 637 North Shaw Road CITYISTATE/ZIP Stockton,CA,95215 <br /> LICENSE Ci-C-42 [I-C-36 OTHER C-57/A-HaZ NUMBER 660227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH: -20 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> - PERC TEST #I 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 ❑ 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 It FOUNDATION ft PROPERTY LINE rM syr <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES 1720 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 8AA1 f­ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH �_ FAA, U/N <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE N CpUNry <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft' P,gRTTAC <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft HENT <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C3 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R 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�1-IOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 11 <br /> SIGNED % �f1 TITLE Sencir Geologist DATE <br /> l <br /> 1 <br /> ✓ � I MENT <br /> EIVE® <br /> 25 2019 <br /> IN CpUNN <br /> MENTAL;uc <br /> PAR <br /> TMENT <br /> FF�FFF I I I <br /> Elb R TME'NoT LAEON Y <br /> Application Accepted By ate Area Employee ID# ' <br /> t rt!nllf�/4M <br /> Final Inspection By Date 4 ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Dept o 3 Pit/Sump oil Character: <br /> COM NTS ' AA I1 <br /> n r RIA PE SC Received h Amount Per IU Invoice# Permit ID# <br /> Code INFO Cash Remitted I Irvice PAqjLeqj# <br /> 31 <br /> 42-01 �I / n0 A-rjPAV�W STEWATER TRTMNT SYSTEM PERMIT <br /> 4114119 QC- ✓`ter v e <br />