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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTGN AVENUE-STOCKTON CA 95205-(209)4633420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 10196 S.Priest Road CrrYZP French Camp,95231 rn <br /> e� <br /> CROSS STREET East Galin Road APN 193220-66 PARCEL SIZE 1.502 e <br /> e <br /> OWNER NAME Michael George PHONE 209 598-2187 <br /> OWNER ADDRESS 9965 S.Priest Road Cm/STATEIZIP French Camp,CA,95231 <br /> CONTRACTOR Advanced GeOEnvlronmenlal,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 637 N Shaw Road Cm/STATE21P Stockton,CA,95215 <br /> LICENSE 11_C-42 ❑_C-36 OTHERC-57/A-Haz NUMBER 660227 EXPIRATION DATE 11/30119 <br /> WATER TABLE DEPTH:—25410 R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ® PERC TEST #1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/AODITKIN _ ENGINEER DESIGNED/ALTERNATNE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gel #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE To NEAREST WELL R FOUNDATION fl PROPERTY UNE R <br /> ❑ FILTERBED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TG NEAREST WELLR FOUNDATION ft PROPERTY UNE it <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH it <br /> DISTANCE To NEAREST WELLR FOUNDATION ft PROPERTY UNE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY UNE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE 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 /> MINIMUM48 HODR ADVANCE NOTICE REQUIREDF I S S-PLEAM CAL 9 9,53-769 <br /> SIGNED TITLE Senior Geologist DATE 31 October 2019 <br /> 2019 <br /> R COUN <br /> NTAt <br /> TMENT <br /> {II <br /> O IFPA R TM ENT UA E O <br /> Application Accepted By DateWCA17 AreaEmployee I� <br /> Final Inspection By Date ❑ SP <br /> IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIUSump Soil Character. <br /> COMMENTS <br /> PE Sc Received Chec Amount D le Permit/ Invoice PermItlD# <br /> Code INFO B s Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/13 <br />