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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESSState Highway 120/French Camp Road-PO Box 314 CITY/Zip Ripon,95366 CROSS STREET French Camp Road APN 203.220-76iP PARCEL SIZE 2.11 OWNER NAME Maria Cervantes Menchaca PHONE 209 610-9109 " OWNER ADDRESS State Highway 120/French Camp Road-PO Box 314 CITY/STATEMp Ripon,CA,95366 CONTRACTOR Advanced GeoEnvironmenlal,Inc(AGE) PHONE(800)511-9300 CONTRACTOR ADDRESS 837 North Shaw Road CrrY/STATE ZIP Stockton,CA,95215 LICENSE (]_C-42 ❑_C-36 OTHER C-57/A-HaZ NUMBER 660227 EXPIRATION DATE 11/30/19 WATER TABLE DEPTH: -60 it GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # r BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: _ NEW INSTALLATION _ .REPAIR/ADDITION ._ ENGINEER DESIGNEDIALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LMNG UN"S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL11 FOUNDATION ft PROPERTY LINE it ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES R DISTANCE TO NEAREST WELLft FOUNDATION it PROPERTY LINE it ❑ FILTER BED WIDTH R LENGTH It DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH it DEPTH it DISTANCE TO NEAREST WELL11 FOUNDATION R PROPERTY UNE R ❑ SUMPS WIDTH R LENGTH R DEPTH it DISTANCE TO NEAREST WELL11 FOUNDATION ft PROPERTY LINE it ❑ DISPOSAL PONDS WIDTH ft LENGTH 11 DEPTH It DISTANCE TO NEAREST WELLft FOUNDATION R PROPERTY LINE it ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY UNE it I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM48 UR ADVANgE NOTICE REQUiRIED FOR INSPECrIONS-PLEASE CALL 953-7697 SIGNED TITLE Senoir Geologist DATE 7/01119 � E� I�E'D 3 Zp19 JUN - [ j[ g EPaR m�iyT EPART EN Tk S ONLY Application Accepted By Date AreaPPERMIT e ID# 'l Final Inspection By Date ❑ Sd by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS ---------------------------------------------------------------------- PE SC Received ChecRal Amount Date I—.— Invoice# Permit ID# Code INFO By ash Remitted rvlce Re uest# 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4!14118