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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 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 12511 Mundy Lane CITY/Zip 95240 — l <br /> CROSS STREET East Hogan Lane APN 061-120.590 PARCEL SIZE 3.03 _ <br /> Smith Michael M 8 Beverly J ETAL 209-467-1006 z <br /> OWNER NAME' . y PHONE r <br /> OWNER ADDRESS 12511 Mundy Lane CITY/STATE/ZlP Lodi,CA 95240 <br /> CONTRACTOR AdvancedGeo,Inc. PHONE 800-571.9300 <br /> CONTRACTOR ADDRESS 837 Shaw Road CITY%STATE/ZiP Stockton,CA 95215 <br /> LICENSE : C42 13=C-36' OTHER S"0fNme4°Y LA mo GedapnlNUNBER W.f" `.'EXPIRATION DATE 01/31/2023 <br /> WATER TABLE DEPTH:70.80 feet ft GEOGRAPHICAL INFORMATION: Coordinates X 38.052918 y 121.150562 <br /> PERC TEST #' I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: .. NEW INSTALLATION REPAIWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: U RESIDENCE I COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG _— _ CAPACITY — gal #OF COMPARTMENTS _ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY _ gal #OFCOMPARTMENTS _ <br /> DISTANCE TO NEAREST: WELL _ ft FOUNDATION _ It PROPERTY LINE <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TD NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ <br /> ❑ FILTER BED WIDTH ft LENGTH_ ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE _it <br /> ❑ MOUNDED WIDTH M LENGTH_ R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH h <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE h <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _h <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ._ _ 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 REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED J TITLE'10Geolog-st DATE 06/16/2021 <br /> S EJEJ JAIT11T A C H E D <br /> �C NjEN T <br /> FI VEo <br /> 222021 <br /> 9 ON <br /> R NA, L/NT, <br /> 6— 407EPART SENT <br /> l - <br /> DEPARTMENT,gg ONLY X11 <br /> Application Accepted By Date Area =I _ Employee ID# UA <br /> Final Inspection By Date ❑ SPECIAL PERMIT•Approved by <br /> Character of Soil to Depth of 3 Ft:_ PIVSump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount to Permit/ Invoice# PermitID# <br /> Code INFO B ash Remitted Service Request# <br /> a 3 's Asa <br /> 4201 / /�� ��/S7� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4.14'1 A l ,;/M-fL, (/Q_ <br />