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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTDN AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J08 ADDRESS 8675 Carey Court CrrY21P Stockton,CA 95212 <br /> M <br /> CROs STReET Shippee Lane APN 085-560-070 PARCEL SIZE 1.533 acres > <br /> 0 <br /> OWNER NAME Dan Galvan _ PHONE(408)523-2292 ` <br /> OWNER ADDRESS 8675 Carey Court CITYISTATE/ZIP Stockton,CA 95212 <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 <br /> CONTRACTOR ADDRESS 837 North Shaw Road CITYISTATE/ZIP Stockton,CA 95215 <br /> CA Professional Geo Brian Millman 1131123 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER 8574 EXPIRATION DATE <br /> WATER TABLE DEPTH: 65-70 it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 9 PE IC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED IALTERNATIVE <br /> I_I REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASrr,TRAP TYPE/MFG __ CAPACITY _ gal #OF COMPARTMENTS__,.____, <br /> DISTANCE TO NEAREST: WELL it FOUNDATION fl PROPERTYLINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 7 LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL R FOUNDATION h PROPERTY LINE it <br /> ❑ FILTER BED WIDTH li LENGTH_ if DEPTH _it <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION_ it PROPERTYLINE fl <br /> ❑ MOUNDED WIDTH R LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTYLINE it <br /> ❑ SUMPS WIDTH_ It LENGTH_ fi DEPTH It <br /> DISTANCE TO NEAREST WELLfl FOUNDATION it PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE it <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 REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 7 <br /> SIGNED_ I Brian Millman TITLE CA Professional Geologist No.8574 DATE 05 March 2021 <br /> 6+-v. <br /> EC MEN r <br /> El vED <br /> AR 112021 <br /> N AQIR ON MEN TA U1N C <br /> T pE AQ TME <br /> CNTY <br /> 1# <br /> DEPARTMENT E ONLY Q <br /> Application Accepted By L-/��---1_ Date D 4 Area L' Employee ID# D <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character o1 Soil to Depth of 3 Ft: PiUSump Sail Character: <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit) Involve# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# , <br /> I-)as a a �-- rsa f -I' �`,I1 6'5f' � <br /> 42.01 '��'X 12-1PGS5;-- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />