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t <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />GALL <br />1 TEAH FHUM UAIlz ISSUL <br />JOB ADDRESS 4504 Virgil Street CnY%ZIP Stockton, CA 95215 <br />CROSS STREET Homer Street APN 087-122-090-000 PARCEL SIZE 0.172 Acres <br />OWNER NAME Hicks, Donald R PHONE (209) 581-7879 <br />OWNER ADDRESS 406 North Ham Lane CITY/$TATE/Zlp Lodi, CA 95241 <br />CONTRACTOR AdvancedGeo, Inc. PHONE 209-467-1006 <br />CONTRACTOR ADDRESS 837 Shaw Road ^7Y/STATE21P Stockton, CA 95215 <br />LICENSE ❑71C-42 E C-36 OTHER Sopellsedby CAPro.GEO NUMBEF \ / :PIRATION DATE 01/31/2023 <br />WATER TABLE DEPTH: 60-70 feet ft GEOGRAPHICAL INFORMATION: Coordinates X 38.002448 y 121.41903 <br />N PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION f REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />f l REPLACEMENT i OUT -OF -SERVICE SEPTIC SYSTEM I 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 />❑ GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE If <br />❑ LIFT STATION SIZE TYPE OF PUMP C3 PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES -1 LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED WIDTH <br />ft LENGTH <br />It <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED WIDTH <br />it LENGTH <br />If <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />It PROPERTY LINE it <br />❑ SUMPS WIDTH <br />ft LENGTH <br />It <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION _ <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />it LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE It <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 <br />REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />TITLE STAFF GEOLOGIST <br />DATE 7/29/2021 <br />11CO A DrAA=Al L If CC nA/1 V — / _ r <br />Application Accept( <br />Final Inspection By <br />Character of Soil t <br />Cp-MM <br />tad 1523 <br />42-01 <br />4/14/18 <br />Cash Remitted <br />sa <br />Invoice# I PurnitID# <br />ONS11E WASTEWATER TRTMNT SYSTEM PERMIT <br />iiiiiiff l L 1 1 �l n /q// n„ 27 I <br />