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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 FERMII <br />JOB ADDRESS 1480 White Lane <br />GALL IZU'J190J-/0J/ FOR <br />CITY21P Stockton, CA <br />CROSS STREET Garnica Court APN 101-280-010-000 PARCEL SIZE 66,319 Square feet <br />OWNER NAME MILLS, DONALD J & LINDA A TR PHONE (209) 470-3295 <br />OWNER ADDRESS 6055 Gerdes Court CITY/STATE/ZIP Stockton, CA 95215 <br />CONTRACTOR AdvancedGeo,Inc. PHONE 209-467-1006 <br />CONTRACTOR ADDRESS 837 Shaw Rodd <br />Cm'/STATE21P Stockton, CA 95215 <br />LICENSE _-C-42 0::C-36 OTHER Supervised By CAPro.Geo NUMBER &-4., Ma-((�� " 1, EXPIRATION DATE I/31/2023 <br />WATER TABLE DEPTH: 70.80 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />ix PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />I 1 REPLACEMENT Il 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 />❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br />❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES <br />:1 LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />Date Perm iU Invoice # Permit IDN <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />it <br />DEPTH it <br />'51Z o 3,4(,P <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE it <br />❑ MOUNDED <br />WIDTH <br />It LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE it <br />❑ DISPOSAL PONDS WIDTH <br />it LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT 1 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 />MINIM M 48 <br />HOUR ADVANCE NOTICE <br />R <br />IR D FOR INSPECTIONS - PLEASE <br />CALL 2 953-7697 <br />SIGNED <br />TITLE Staff Geologist <br />DATE 4/30/2021 <br />D PARTMENT <br />.;USE ONLY Q <br />Application Accepted By. - L i Date S �. � Area Gql / Employee ID#)A <br />Final Inspection By Date �S! �?� ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS %1'7' add cess is 6o5'S" Cf. Sk4lori <br />PESC <br />Received <br />Check#/ <br />Amount <br />Date Perm iU Invoice # Permit IDN <br />Code <br />INFO <br />ash <br />Remitted <br />Service Re Uest # <br />;a <br />Ta3 aW <br />ViS-4-1416R <br />'51Z o 3,4(,P <br />4 --# 1214 0 4S-E� `'y ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14//14/ 18bx; <br />l^� <br />