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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAt.TH DEPARTMENT 1868 E, HAZELTON AVENUE- STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (2091 953-769 7 FOR bNSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED ........ _ ......_...... ..... JOS ADDRESS 4504 Vlrpti Street Crryrbp Stockton, GA 95215 CROSS STREET Homer Street 087-122090-000 PARCEL SIZE 0.172 Acres OWNER NAME HiCks, Donald q __....__....:._...._....___ _ PHONE. '.�9) 561 7879 OWNER ADDRESS 406 North Ham Lane CITY/STATE/ZlP Lodi, CA 95241 CONTRACTOR AdvancedGeo, Inc. PHONE 209-467-1006 CONTRACTOR ADDRESS 837 She* Road — _ ry ^-rY!STATEILP Stockton, CA 95215 LICENSE 3 -'C-42 i....:: G36 OTHER Su!!! is ! CA Ps -GEO NUMSEF 6,.i,, 'I «"" ;.'I3IRATTON DATE 01131!2023 WATER TABLE DEPTH: go'70 feel it GEOGRAPHICAL INFORMATION: Coordinates X 38.007448 y 121 41903 PERC TEST #? _ BUILDING PERMIT #_........... __ ,__,..,,_,,,_.,,__ LAND USE APPLICATION —TYPE OF WORK:NEW INSTALLATION .W.J.....-.-.� . REK+`AI 'y{D017WN _.. ENGINEER DE=NE0 /ALTERNArivE REPLACEMENT OUT -CIF -SERVICE SEPTIC SYSTEM DESTRUCTION ......__._.._..._..._.... 1 ...........__-___- INSTALLATION WILL SERVE: _: RESIDENCE 'I COMMERCIAL NUMBER_____- OF-UvtNO._..._...UNI..._T..S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG ......_... ........... ...... ...... _......_......___............. ............................. _,......- CAPACITY......,.,,,,_,.. gal #OFCOMPARTMENTS . O GREASETRAP TYPEIMFG—._........ _._._.___._..__ CAPACITY_ ........_..._..... gal #OF COMPARTMENTS ....... _... _....... _........ _. it PROPERTY LME R DISTANCE TO NEAREST: WELL. ft FOUNDATION i1 PROPERTY LINE H O LIFT STATION SIZE TYPE OF PUMP ❑ PKG T% PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) (3 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft D e DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LME R O FILTER BED WIDTH h LENGTH it DEPTH tt DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE - Y: O MOUNDED WIDTHft .._............ _ _..._....__......., LENGTH ... ............. ft DEPTH h . DISTANCE TONEAREST WELL ......................._.................. ft FOUNDATION .... ... ti PROPERTY LINE ....... © SUMPS WIDTH _.. ... ft LENGTH _............._..._—. ,,. .. fl DEPTH..,_..,_______.....__,__.._...... DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE it 0 DISPOSAL PONDS WIDTH ft LENGTH it DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE it 0 SEEPAGE PITS NUMBER WIDTH It DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTYLINE R 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 1209) 953-7697 SIGNED rHOUR �.7� TITLE STAFF GEOLOGIST DATE 7494021 DEPA RTMENri USE Off_ Ir Application Accepted By .,/1 Date a' ] Area Employee ID#.._. Final Inspection By �.�_._____....._..._ Date SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 R: PitiSump Soil Character:._ COMMENTS PE Code SC Receiv INFO ChaFk#/ Cash Amount Remitted D e Permit! 5 rvice a St # if j D# ParntiilD# ? 53 _ Ids f 422.0 1.01 g�.,4 4 j ry ✓i .i T WASTEWATER TA'fMNT SYSTEM PEAMIT 4 l8 l%r irr E W A it