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1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E.HAZELTON AVENUE-STOCK TON CA 85205.1200)468,3420 <br /> ✓J NON-R_EFUNDABLE PERMIT CALL(209)953.7697FOR INSPECTIONS ExP1RES 1 YEAR FROM DATE ISSUED <br /> 11560 West Clover Road CITYIZIP Trac95304y, m <br /> Joe AooaEss ,. � <br /> CROSS STREET Corral Hollow Road _ APNN2212.200.220 PARCEL SIX$ 1 16 e <br /> OWNaR NAME Vaneffa 8 Vlgil Pura PHONE 209 640.4909 ac�-.fes — � <br /> OWNLR AODRESe 1 iS60 Wesl Clover ROatl _ _ __`CHYISTATEIZIP Tracy,CA.95304 <br /> CONTRACTOR Advanced GeoEnvlronmonlol,Inc(AGE) pHONE(800)511.9300 <br /> CONTRACTOR ADDRESS 837 North Show Road CITWSTATEIZIP Stockton,CA,95216 <br /> LIOENSE CI..0-42 C1..0-38 OTHER C-571A-Haz NUMBER 680227 EXPIRATION DATE 11130119 — <br /> WATER TABLE DEPTH: -20 f1 GEOGRAPHICAL INFORMATION: Coordinate! X Y__ <br /> PERC TEST #r BUILDING PERMIT# LANO USE APPLICATION# l <br /> TYPE OF WORK: _ New INSTALLATION RI'MR/Aw NTtON - NOINEER ESIONEO(ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICF.SEPTIC SYSTEM _ DESTRUCTION <br /> ff­-NUMRFR <br /> ALLATION WILL SERVE: (jRESIDENCE [I COMMERCIAL L OTHER I <br /> OF LIyING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLoyem <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS___ _. <br /> ❑ GREASE TRAP TYPEIMFG CAPACITYgal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION _ R PROPERTY LINETA <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Jul❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES , <br /> DISTANCE TO NEAREST WELL R FOUNDATION_, iPROPERTY LINE vV O19 <br /> ❑ FILTER BED WIOTH R LENGTH ____-_R DEPTH _ _lALli ()pV CO U <br /> DISTANCE To NEAREST WELL it FOUNDATION — _ it PROPERTY UNE_ �I rJ� _-v IVM Njy <br /> ❑ MOUNDED WIDTH R LENGTH fl DEPTH_. tP"PART TAC <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE it MENTI <br /> ❑ SUMPS WIDTH fl LENGTH ,,,- II DEPTH _R <br /> DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE <br /> ❑ DISPOSAL PONDS W10TH it LENGTH___ Il DEPTH _,R <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION fl PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIOTH it DEPTH fl <br /> DISTANCE TO NEAREST WELL Il FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT-1 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED__. _ I i' i+ , l' TITLE Senoir Geologist DATE 5I30J19- ! 1(.-,I lj <br /> I <br /> 1 I r <br /> Ajejr <br /> - - <br /> 25 2010 <br /> IN MENTANTM <br /> pARTMENT <br /> hfEN EON yApplication Accepted Byate Area EmployeeFinal Inspection By ate ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Dept or*"�8 <br /> Pit/Sump oil Character: <br /> COMMENTS 11,11 r 10 WW ' A- 4A1 <br /> At� �_ M <br /> PE SC Received h Amount Per IU <br /> Code INFO Cash emitted Dale ervice es # Invoice# PermitlD# RIA <br /> 931 <br /> 2all <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4!14118 <br />