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) H3s3 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE- STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABI F PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESF 43$3 West California Avenue CITv/ZIP Tracy, CA 95304 <br />CROSS STREET Canal Blvd ApN 213-180-53 PARCEL SIZE <br />OWNER NAN -3V-c!Yt YYI ti � } I ne L PHONE (209) 229-3817 <br />OWNER ADDRESSI �� / CITY/STATE/ZIP Tfe.4y 993 -76 <br />CONTRACTOR AdvancedGeo,Inc. PHONE 209-467-1006 <br />CONTRACTOR ADDRESS 837 Shaw Road <br />LICENSE ❑ =-C-42 ❑ -C-36 OTHER Supervised by CA Pro. GEO NUMBE 6� <br />CITY/STATE2IP Stockton, CA 95215 <br />01/31/2023 <br />WATER TABLE DEPTH: 40-50 feet It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />® PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION C ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE -I COMMERCIAL I- 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 # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES LEACHING CHAMBERS <br />#OF LINES <br />LENGTH OF LINES It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />It PROPERTY LINE ft <br />❑ FILTER BED WIDTH It LENGTH <br />If DEPTH ft <br />DISTANCE To NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE til <br />❑ MOUNDED WIDTH it LENGTH <br />ft DEPTH fit <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTYLINEL <br />❑ SUMPS WIDTH It LENGTH <br />It DEPTH NRA i <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />�4 <br />It PROPERTY LINE f� <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH it <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH it <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />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 <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED _ <br />TITLE Staff Geologist <br />DATE 01/1812022 <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Dept <br />COMMENTS Afar <br />/DEPARTMENT USE ONLY <br />L Date Area j q q Employee ID# <br />Date ❑ SPECIAL PERMIT - Approved by <br />If 3 F/ USump Soil Character: <br />r <br />Date " 'e " Invoice # Permit ID# <br />Code INFO Oyu, Remitted I j Service Re uest # <br />�I23 a Sa3 k'5a_ I *-158 riT k- �Mt e <br />42-01 <br />4/14/18 <br />6j,V' �F/37X)Sol3 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Z 3° <br />n <br />z <br />