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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 17454 Von Sosten Road CITY/ZIP Tracy,95376 <br /> m <br /> CROSS STREET Von Sosten Court APN 209-460-100-890-• PARCEL SIZE 1.670 c <br /> 0 <br /> OWNER NAME Jaspal&Surinder Randhawa PHONE 209 914-2056 y <br /> OWNER ADDRESS 17454 Von Sosten Road CITY/STATE/ZIP Tracy,CA,95376 <br /> CONTRACTOR Advanced GeoEnvironmenlal,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 N Shaw Road CITY/STATE/ZIP Stockton,CA,95215 <br /> LICENSE I C-42 LI-C-36 OTHER C-57/A-HaZ NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH:—20 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 15( PERC TEST #I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDRION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE L COMMERCIAL I 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OFLINEs LENGTHOFLINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 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 HOUR ADVAN E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 953-7697 <br /> SIGNED I' TITLE Senior Geologist DATE 14 August 2019 <br /> 11 IL 11 11 111 11 <br /> I IL 11 11 1 11 111 11 111 <br /> 11 IL 1 11 <br /> YMENT <br /> CEIVED <br /> G 16 2019 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEk1rH DEPARTMENT <br /> j D�EA MENOCApplication Accepted B � i Area Employee ID#�Final Inspection By ate 2 _1 $PE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pitt mp Soil Character: <br /> COMMENTS Grp 0 o- '0 C © /l I O�I'1� O <br /> a <br /> PE SC Receiveda Amount Permit/ Invoice# Permit ID# <br /> Code INFO B Cash emitted Date Service Re uest# <br /> OL <br /> NT� <br /> 42 k" SITEWASTEWATERTR M0�TEM�1PrEReMsIT�e- <br /> � <br /> 41-�8P oil e gedlx+ vvkl� 6e � <br />