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z <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 10196 S.Priest Road CITY/ZIP French Camp,95231 r <br /> CROSS STREET East Galin Road APN 193-220-68 PARCEL SIZE 1.502 <br /> C <br /> PHONE <br /> OWNER NAME a <br /> Michael Georg 209 598-2187 <br /> OWNER ADDRESS 8965 S.Priest Road CITY/STATE/ZIP French Camp,CA,95231 <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 C-42 C-36 OTHER C-57/A-HaZ NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH:-25-30 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: RESIDENCE 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 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <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 R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH 1t 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 48 HObR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 2 9,53-7697 <br /> SIGNED TITLE Senior Geologist DATE 31 October 2019 <br /> �lVT <br /> 1U"g <br /> R <br /> NTAL <br /> TMEIVT <br /> O PARTMENT UAEO L <br /> Application Accepted B Date Area Employee ID <br /> Final Inspection By Date L. SP IAL PERMIT-Approved by <br /> Character of Soil to Death of 3 Ft: p oil aracter: <br /> COMMENTS / c� Z - D /"P74177, ) I L <br /> PE SC Received Chec Amount D to Permit/ Invoice# Permit ID# <br /> Code INFO B s Remitted Service Re uest# <br /> 2 it 14 q � <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />