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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 />IVUN-14EFUNUAt3LE YEHMII L.ALL (711`4) M3J-/O4/ f UH IN9YtC;I IUA <br />JOB ADDRESS 26955 Hansen Road CITY21P <br />CROSS STREET I-580 APN 209-110-090-000 <br />OWNER NAME SandhU KUlwant Kaur TR <br />OWNER ADDRESS 2101 Park Warren CT <br />CONTRACTOR AdvancedGeo, Inc. <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />CA 95377 <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />PARCEL SIZE 7.79 <br />p <br />PHONE (833)-717-3200 <br />C <br />Los Banos, CA 93635 <br />PHONE 209-467-1006 <br />CONTRACTOR ADDRESS 837 Shaw Road ,, —CITY/STATE/ZIP Stockton, CA 95215 <br />❑ <br />LICENSE ❑ [1::C -36C -42[1::C-366 OTHER Supervised by CA Pro. Geo NUMBER,[c�, <br />S` @ _ EXPIRATION DATE I/31/2023 <br />WATER TABLE DEPTH: 15-20 ft GEOGRAPHICAL INFORMATION: Coordinates X 37.423638 Y 121.304979 <br />® PERC TEST # ' BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />Il REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM Ll 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 #OFCOMPARTMENTS <br />❑ GREASETRAP TYPE/MFG CAPACITY---- gal #OFCOMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES I LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE _ _ ft <br />❑ FILTER BED WIDTH <br />ft LENGTH <br />it DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE ft <br />❑ MOUNDED WIDTH <br />ft LENGTH <br />it DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE ft <br />❑ SUMPS WIDTH <br />it LENGTH <br />it DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />it PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />it LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTYLINE ft <br />❑ SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE 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 HQUR ADVANCE NOTICE <br />RE <br />IRED FOR INSPECTIONS <br />- PLEASE CALL 29) 953-7697 <br />SIGNED <br />TITLE Staff Geologist <br />DATE 11/8/2021 <br />DEPARTMENT USE O Ly <br />Application Accepted By L Date 1 Area S Employee ID#_ A <br />Final Inspection By Date 7 SPECIAL PERMIT - Approved by <br />Character of SolI toDip h �'^ <br />f 3 Ft:Pit/Sump Soil Character: <br />COMMENTS 'Y t 7 l — �'�"1 iM 1 ^ <br />PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# <br />Code INFO Cash Remitted Service Request # <br />as 5,23 <br />4 -01 �n / I $ l `( Z(Pf1615iE WASTEWATER TRTMNT SYSTEM PERMIT <br />I <br />