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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 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2111 Waudman Avenue CrTY/ZIP Stockton,CA 95209 <br /> CROSS STREET Thornton Road APN 080-290-260 PARCEL S12E 0.40 acv- <br /> OWNER o <br /> 0 <br /> NAME Denise and Anton Rivera PHONE(925)325-4664 ,�'_ I T <br /> OWNER ADDRESS 2111 Waudman Avenue CrTY/STATE/ZIP Stockton,CA 95209 rJ <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800511-9300 ,p ,y <br /> CONTRACTOR ADDRESS 837 North Shaw Road CITY/STATE/ZIP Stockton,CA 95215 <br /> CA Professional Geo Brian Millman 1/31123 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER 8574 EXPIRATION DATE <br /> WATER TABLE DEPTH: 25-30 it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 9 PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION D ENGINEER DESIGNED/ALTERNATIVE <br /> U. REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM u 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 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT (3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES J LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE Y <br /> ❑ FILTER BED WIDTH It LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE C`Lam/�'Y <br /> E3MOUNDED WIDTH It LENGTH it DEPTH _It �O <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE �.� 1 <br /> E3 SUMPS WIDTH if LENGTH it DEPTH 11� it 6 ?O?1 <br /> DISTANCE To NEAREST WELL it FOUNDATION it PROPERTY LINE N./Q It <br /> ❑ DISPOSAL PONDS wwrH It LENGTH ft DEPTH � r'. U!N C <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE�TN fb MEN�UNT y <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It PgRTM C <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTYLINE It FNT <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 <br /> SIGNED_ y-`'`° Brian Millman TITLE CA Professional Geologist No.8574 DATE 11 March 2021 <br /> B o.tTtiL 1�(� <br /> III IL <br /> JIL <br /> DEPARTMENTSE IN <br /> Application Accepted By � / J�_— Date 74> ✓✓ Area - -/ / Employee ID# !� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Sol]Character: <br /> COMMENTS <br /> PE Sc Received Check#! Amount -Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Se ice a ues # <br /> aJ S 3 �a��•I�!="J_ Ili <br /> 432-- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/A4l1e <br />