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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 1177 Nonh Stokes Avenue CITY/ZIP Stockton.95215 r <br /> CROSS STREET East Fremont Street APN 143-280-01 PARCEL SIZE 3.01 Acres <br /> PHONE OWNER NAME <br /> Stockton Terminal Eastern RR Co. 510 835-7251 z <br /> OWNER ADDRESS 1177 North Stokes Avenue CITY/STATE/ZIP Stockton,CA,95215 <br /> CONTRACTOR Advanced GeoEnvironmenlal,Inc(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 North Shaw Road CITY/STATE/ZIP Stockton,CA,95215 <br /> LICENSE . C-42 I C-36 OTHER C-571 A-HaZ NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAFUADDITION ENGINEER DESIGNED IALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE I 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 H <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH H DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH ft 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 It 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL H 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 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 2 953-7697 <br /> SIGNED ,l/'- i-- TITLE Senoir Geologist DATE 5130/19 <br /> T ? <br /> IPA I,- <br /> IVT <br /> 1VE® <br /> s 2019 <br /> ��NTY <br /> NTA <br /> r�FNr <br /> DEPARTMENT USE NLY (�[/ <br /> Application Accepted By + Date Area ��_' tmployee ID# - <br /> Final Inspection BjDeth <br /> //YQ;ate t SPE91AL PERMIT-Approved by <br /> Character Of Soil tof 3 Ft: Pit/Sump Soil Ch rade. <br /> COMMENTS_ C nI'l <br /> [,�Io tx Y a,4r P ► o S <br /> PE SC Received Chef Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO 8 Remitted ervice BwAt# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />