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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1901 N.Patterson Avenue CITYIZIP Stockton,CA 95215 n <br /> CROSS STREET East Fremont Street APN 089.091-08 PARCELSVE 0.228 acres e <br /> OWNER NAME Jose Gutierrez PHONE 209 271.7508 <br /> OWNER ADDRESS 2345 E.Acacia Street CITYISTATFJZIP Stockton,CA 95205 <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 <br /> CONTRACTOR ADDRESS 837 North Shaw Road CITYISTATE/ZIP Stockton,CA 95215 <br /> LICENSE ❑-C42 (_I_.C-36 OTHER C-57 NUMBER 1063765 EXPIRATION DATE 02/28/2022 <br /> WATER TABLE DEPTH: 70410 tl GEOGRAPHICAL INFORMATION: Coordinates X Y I <br /> PERC TEST # t BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: - NEW INSTALLATION REPAIRIADDITION - ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: U RESIDENCE U COMMERCIAL U OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ' <br /> DISTANCE TO NEAREST: WELL A FOUNDATION It PROPERTY LINE it 1 <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACHLINES E LEACHING CHAMBERS #OFLINES LENGTHOFLINes ft <br /> DIsTANCETO NEAREST WELL It FOUNDATION ft PROPERTY UNE fl <br /> ❑ FILTER BED WIDTH n LENGTH R DEPTH ft I <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTYUNE ft <br /> ❑ MOUNDED WIDTH n LENGTH R DEPTH n j <br /> DISTANCE TO NEAREST WELL n FOUNDATION n PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH YM�• , 1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE C� <br /> cN/ <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH n DEPTH fl /Vil§D <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYUNE AA <br /> �1 <br /> LI SEEPAGE PITS NVMBER WIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELLft FOUNDATION n PROPERTY UNE � l�. <br /> I HEREBY CERTIFY THAT I HAVC PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDIINAJOQ A� �O I <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I VIN O <br /> MINIMUM R ADVANCE NOTICE REQUIRED FOR INSPECTIONS Project g -PLEA$E CALList DATE 0510812920-769 SALT H pg /V r4 t <br /> SIGNED AI <br /> I <br /> i <br /> 1 <br /> I <br /> I <br /> J <br /> 1 i j <br /> L <br /> I <br /> I <br /> l <br /> f <br /> 1 <br /> DEPARTMENTS `ONLY ! <br /> " J y Employee ID# _ <br /> Application Accepted By /_f / Date ,, l J 0 Area <br /> Final Inspection By Date E) SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 31 Fl: Pit/Sump Soil Character: <br /> COMMENTS �'�7l' 1 ^FID}1 G��'F' C I'1C �:'�� 1 P L <br /> f>1011'ts/ul r4'ISfif'1'rVIP/� till Sl.jt- VV0 II'/' <br /> PE Sc RecelvedCheck#! Amount FermiU # PermitID# <br /> Date Code INFO ash Remitted Service Request# Invoice <br /> I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114116 <br /> ( <br />