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- <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 14499 East Collier Road CITYIZIP Acampo 95220 <br /> CROSS STREET Fuhrman Road APN 021-030-39 PARCEL SIZE 4.56 0 <br /> 0 <br /> OWNER NAME Rafael Navarro PHONE 209 808-2201 y <br /> OWNER ADDRESS 26618 N 99 HWY CITYISTATE/ZIP Acampo,CA 95220 <br /> CONTRACTOR Advanced GeOEnvironmental,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 N Shaw Road CITYISTATE/ZIP Stockton,CA,95215 <br /> LICENSE C-42 [J-C-36 OTHER C-57/A-HaZ NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH:-160 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST #1 1 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: I_ RESIDENCE I 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 ft PROPERTY LINE ft <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 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 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 ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <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 48,H6UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209).9.53-76,97 <br /> / ist DATE 03 October 2019 Senior Geologist SIGNED � � TITLE 9 <br /> EN? <br /> -1 VE <br /> ® <br /> 2019 <br /> AftU <br /> Q1& COUNTY <br /> OJOVENTAL <br /> P RTMENT <br /> r"�� DEPARTMENT USE ONL C / <br /> Application Accepted By /i" Date rea L `� Employee ID#��- <br /> Final Inspection By Date I SP ALP RMIT-Approved by <br /> Character of Soil to De9th of 3 Ft: Pit/Sump Soil Character:' <br /> COMMENTS 1,'e t•J <br /> OPE SC Received C�heck�#-' Amount Date Permit/ Invoice# Permit ID# <br /> de INFO B Cash Remitted rvice Re uest# <br /> u a�10 -� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />