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I CIA <br /> 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 228 KID Road CITY/Zip Lathrop,95330 <br /> q <br /> CROSS STREET Manthey Road APN 191-240-18111110' PARCEL SIZE 1.61 Do <br /> 0 <br /> OWNER NAME Javier Leon PHONE 209 923-7496 <br /> OWNER ADDRESS 484 Pestana Avenue CITY/STATEIZIP Manteca,CA,95336 <br /> CONTRACTOR Advanced GeoEnvironmental,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 N Shaw Road CITY/STATE/ZIP Stockton,CA,95215 <br /> LICENSE (I-C-42 ❑-C-36 OTHER C-57/A-Ha2 NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH:9M -20 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> D,-< 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: ❑ RESIDENCE ❑ COMMERCIAL L 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 ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <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 ft LENGTH ft DEPTH It <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 ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 49 UR ADVANCEIRE INSPECTIONS E 7 <br /> SIGNED TITLE Senior Geologist DATE 03 October 2019 <br /> Nr <br /> O <br /> 9 <br /> DEPARTMENT US152 ONAL Y <br /> Application AcceptedDate Ar Employee ID#�_ <br /> Final Inspection By Date 11S CIAL PERMIT-Approved by <br /> Character of Soil to Depthof Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> P QiYGD a b-T A r 3 1;1" L <br /> PE SC Received AmountDate PermlU Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> ► a <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />