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4 • 4 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1865 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 462 West Joseph Road CITYIZIP Manteca 95336 _N m CROSS STREET North Main Street APN 216-310-180 PARCEL SIZE 0.460 acres o 0 OWNER NAME Kevin and Diane Wentworth PHONE(209)969-2646 y OWNER ADDRESS P.O.Box 4233 CITYISTATEIZIP Manteca,CA 95337 CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 CONTRACTOR ADDRESS 837 North Shaw Road P xry�� CITY/STATE/ZIP Stockton,CA 952155 LICENSE f. C-42 ]_C-36 OTHERr I NUMBER_� w��gXPIRATION DAT ` � J/ 17 WATER TABLE DEPTH: 20-30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE 'I COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY_ gal 4 O COMPARTMENTS ❑ GREASETRAP TYPE/MFG - _ CAPACITY _. gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH fl DEPTH f w` NT DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE M Ll WIDTH ft LENGTH ft DEPTH E��IE DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTYLINE__ fI VED ❑ SUMPS WIDTH ft LENGTH ft DEPTH '1t DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE V 2 0 �O^O ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH rft L DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE J/4ry"JFNl-t''4Q0I NUMBER RON ❑ SEEPAGE PITS DISTANCE TO NEAREST WELL ft fl FOUNDATION Ift ft EPTPROPERTYLINE �IY �E qR TA Ty --------- ---- ------ ___._.. NT I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED _Brian Millman_ _ TITLE CA Professional Geologist No.8574 DATE 17 August 2020 DEPARTMENT US-E ONLY SK Application Accepted By -� _ Date 7d ah a' Area .3� Employee ID# K __ Final Inspection By Date 'Y—ad o _ ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: _. Pit/Sump Soil Character: COMMENTS PE SC Received Check#I Amount Date Penn itl Invoice# Permit ID Code INFO .Cash Remitted Se i uest# 1 ;isa 4/14/ (�M; 1/ //�p )/�/ J ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118 _�(