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r l <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 21589 Lammers Road Crry21P Tracy,95304 L4 <br /> m <br /> CROSS STREET Grant Line Road APN 209-280-510-000 PARCEL SIZE 10 acres O <br /> e <br /> OWNER NAME FEROZ BARYALAI 8 LAMIA PHONE(209)612-7248 <br /> OWNER ADDRESS 17865 South Austin Road Cm/STATE/ZIP Tracy,California 95336 <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 <br /> CONTRACTOR ADDRESS 837 North Shaw Road CITY/STATE/ZIP Stockton,CA 95215 <br /> LICENSE 0-C-42 0:-C-36 OTHER CA PG NUMBER 8574 EXPIRATION DATE 01/31/21 <br /> rla�man <br /> WATER TABLE DEPTH:20-30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST #1 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR/ADDITION G ENGINEER DESIGNED/ALTERNATIVE <br /> I i REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM G DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL _ it FOUNDATION it PROPERTYLINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 7 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ _ft PROPERTYLINE_ ft <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH - it <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE-_ ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 PAYMENT <br /> SIGNED_ Bfian Millman TITLE CA Professional Geologist No.8574 DATE 28 September 202PECEI VED <br /> P 2 9 2020 <br /> IRONMUINENTA�N <br /> DEPARTMENT <br /> J DEPARTMENT VSEQNL V <br /> Application Accepted By �� L/L� Date 0 Area S —!-'/ Employee ID#D_ <br /> Final Inspection By e 14-g❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D�ePtj Ft: PIVSump Soil Character: <br /> COMMENTS—�.J I !'� "iF` fSs f eV i^^-U' <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Byn Cash Remitted Service Re uest# <br /> a Visa sdTY-1 oovng i I? <br /> ,` <br /> 42-0ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 2-qJ <br />