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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_(ZOV <br />Joe ADDRESS 14250 South Jack Tone Road <br />CROSS STREET French Camp Road / Lone Tree Road <br />OWNER NAME Richard and Valerie Van Linen <br />OWNER ADDRESS 23212 Austin Road <br />CONTRACTOR AdvancedGeo,Inc, <br />203-050.2 <br />Manteca, 95336 <br />9 PARCEL SIZE 10 acres <br />PHONE(209)480-8862 <br />CITVISTATE/ZLP Ripon CA 95366 <br />PHONE 800 511-9300 <br />CONTRACTOR ADDRESS 837 North Shaw Road CITWSTATE/ZIP Stockton, CA 95215 <br />Supervisedby 8674 " "` 4&N 1!31123 <br />LICENSE .-C-42 [ _- C-36 OTHERCA Professional GoolOgiNUMeER EXPIRATION DATE <br />i <br />WATER TABLE DEPTH: 60-70 feet ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />0 PERC TEST # 1 I BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: f; NEW INSTALLATION �^ t REPAIR/ADDITION C ENGINEER DESIGNED/ALTERNATIVE <br />I ; REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM i DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE I COMMERCIAL G OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />O SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS _ <br />O GREASETRAP TYPEIMFG CAPACITY „W,W. gal #OFCOMPARTMENTS,,,,,.T,��_.__. <br />DISTANCE TO NEAREST: it FOUNDATION__,_,.,_ it PROPERTY LINE h <br />O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES � <br />DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE v{^il� <br />O FILTER BED WIDTH it LENGTH.. it DEPTH ...... `_,__,_......._._..____..._. <br />DISTANCE TO NEAREST WELLIt FOUNDATION it PROPERTY UNE J ry <br />O MOUNDED WIDTH ft LENGT i , _ _ft DEPTH _ _J it C �7 <br />DISTANCE TO NEAREST WELLR FOUNDATION, -„ ft PROPERTY LINE ,_. <br />O SUMPS WIDTH —...__._..._..... ft LENGTH .__ (f DEPTH _. ��L.-' /R(Dj CO ,A <br />DISTANCE TO NEAREST WELL _ ft FOUNDATION _._ft PROPERTY LINE ,,,,�. CJ,/�gV��ti y <br />U DISPOSAL PONDS WIDTH ft LENGTH it DEPTHit Rln1�NT <br />DISTANCE TO NEAREST WELL ........................................ It FOUNDATION _ it PROPERTY LINE <br />O SEEPAGE PITS NUMBER WIDTH It DEPTH It <br />DISTANCE TO NEAREST WELL it FOUNDATIONit 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 />AAIAI M tA# 46 HOUR aDVANZE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 1209)953-7697 <br />��� ��t�t�t���t�t�t�t��tt�l>•t��tr�����r■���1�� ��1 <br />NT <br />Application Accepted By ... .__D E P A RDateE 7 U t E rr t7�L_ Y Area J _ i?..._ Employee 1D# <br />Final Inspection By _ Date _. SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 FI PIVSump Soil Character: <br />COMMENTS <br />PE S Received <br />Code INFO By <br />Check#/ <br />Oash <br />Amount Date Parm tt Invoice # Permit IDN <br />Remitted Service Request # <br />4207 l ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <br />ii11 1p <br />