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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 (;ALL (LU.9) &0J -1b&1 FOR INSPECTIONS tXPIRES 7 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 16402 Escalon Bellota Road CITV/ZIP Escalon 95320 <br />CROSS STREET Magnolia Avenue APN 229-080-280-000 PARCEL SIZE 0.979 acres <br />OWNER NAME Larry AZevedo PHONE (209) 495-0850 <br />OWNER ADDRESS 16402 Escalon Bellota Road CITY/STATE/ZIP Escalon CA 95320 <br />CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 <br />CONTRACTOR ADDRESS 837 North Shaw Road -CITY/STATE/ZIP Stockton, CA 95215 <br />Supervised by �A <br />LICENSE 0.1C42 [3::C-36 OTHERCA Professional GeologiNUMBER 8574 s ✓ EXPIRATION DATE 1/31/23 <br />WATER TABLE DEPTH: 80-90 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />0 PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: _ NEW INSTALLATION L REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE J COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />L1 SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br />O GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE it <br />O LIFT STATION SIZE TYPE OF PUMP C3 PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE ft <br />0 FILTER BED WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />O MOUNDED WIDTH <br />it LENGTH <br />it DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />O SUMPS WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />O DISPOSAL PONDS WIDTH <br />it LENGTH <br />it DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />O SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft 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 <br />REQUIRED <br />FOR INSPECTIONS <br />- PLEASE CALL (209) 953-7697 <br />DEPARTM-•'T U?j ONLY <br />Application Accepted B LZL� L, Date B 31 .Z Area Employee ID# A& <br />Final Inspection By 5�(�iY1r n6U Date_ 2 ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 1>e/0 ptte6 w 7e 'q, rt><e 3'33 Z x� <br />PE SC Received Check#/ Amount at Permit] Invoice # Permit ID# <br />Code INFO By_ Cash, . Remitted S rvice Request # <br />; s�3 ISG3 <br />42-01�05 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14,18 / •�,�'„l' ���(II ���' `�"/7 / <br />ICE/ <br />IUjEN T <br />EI vED <br />G 312022 <br />RUIN COLJNTY <br />O vfoe <br />PA NTAL <br />NT <br />