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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 /> Joe ADDRESS 17053 Victory Ave CITY/Zip Oakdale,95361 n <br /> CROSS STREET Pleasant Valley Road APN 229-210-17 PARCEL SIZE 9'37 0 <br /> OWNER NAME Antonio Albor PHONE 209 918-7023 <br /> OWNER ADDRESS 17053 Victory Ave CITU/STATE/ZIP Oakdale,CA 95361 <br /> CONTRACTOR Advanced GeoEnvironmenlal,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 N Shaw Road CITY/STATEIZIP 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:-95 It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> IK PERC TEST #1 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: L; 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 ft FOUNDATION It PROPERTY LINE ft <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 It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <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 It PROPERTY LINE It <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 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONSPLEASE <br /> SIGNED <br /> TITLE Senior Geologist DATE 03 <br /> DEPARTMENT UgE ONLY /� <br /> Application Accepted B Date Area Employee ID# d <br /> Final Inspection By Date ❑ S AL PERMIT-Approved by <br /> Character of Soil to Dept,of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> C o a 1�lit6 6 <br /> PE Sc Received heck# Amount Permit/ <br /> Code INFO B s emitted Date Service Re uest# Invoice# Permit ID# <br /> 4 a <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />