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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95206 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT C <br />JOB ADDRESS 17454 Von Sosten Road <br />CROSS STREET Von Sosten Court <br />OWNER NAME Jaspal & Surinder Randhawa <br />OWNER ADDRESS 17454 Von Sosten Road <br />CONTRACTOR Advanced GeoEnvironmenlal, Inc. (AGE <br />CONTRACTOR ADDRESS 837 N Shaw Road <br />953-7697 FOR INSPECTIONS tXPIRE5 T TEAR FRUM UAIE IJSUt <br />CrrYIZIP Tracy. 95376 <br />ADN 209-460-100.9"- PARCEL SIZE 1.670 <br />PHONE 209 914-2056 <br />I-Y/STATEMp Tracy, CA, 95376 <br />PHONE (800)511-9300 <br />Cm/STATE/LP Stockton, CA. 95215 <br />LICENSE I C-42 ; C-36 OTHER C-57 / A-Haz NUMBER 680227 EXPIRATION DATE 11/30/19 <br />3 <br />WATER TABLE DEPTH: -20 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />15( PERC TEST # I BUILDING PERMIT # <br />#OFUNES <br />LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPAIRIADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: I RESIDENCE <br />I COMMERCIAL <br />I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASETRAP TYPE/MFG <br />CAPACITY <br />gal #OFCOMPARTMEHTs <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />R PROPERTY LINE fl <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br />#OFUNES <br />LENGTH OF LINES it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY UNE ft <br />❑ MOUNDED <br />WIDTH <br />it LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE R <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />it <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />❑ SEEPAGE PITS <br />NUMBea <br />WIDTH <br />ft DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />R FOUNDATION <br />R 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 />421/�(-( { V <br />4/1414/ 13 / <br />Pa,r�;� l y <br />DATE 14 August 2019 <br />,YMENT <br />CEIVED <br />16 2019 <br />QUIN COUNTY <br />ONMENTAL <br />DEPARTMENT <br />Employee ID# A C 'Ao l <br />- Approved by <br />I <br />S STEM PERM'' <br />0,94 5s'a iy'-1qL v <br />