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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1866 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALL Z09 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS Zors'1 N ' 13U Gk R -t> • CITY/ZIP _>�/4-n%1_PIZ) rC-J-ZD CROSS STREET SD UIW QAC-Jq -9Z> APN O I'1 2 Q 2- a PARCEL SIZE 9' 2-& Ac OWNER NAME c/o &Ae& Sn LErz-' GTS CONST. 2( - 09 PHONE 3,p1Z OWNER ADDRESS R Q' 30)(I1 0 CITY/STATE/ZIP ��1"L--T Gly 9S(v32- CONTRACTOR LIVE OAKGEO'r+NVIIIQo^'n'1EN-11�CL TYPE/MFG PHONE 3Co9-o3-7T CONTRACTOR ADDRESS -40, w • o A14 ST • CITY/STATE/ZIP LD'P( cA 9 S 2 4 o LICENSE I C -42 -I C-36 OTHER C G NUMBER 2-1 S" 1 EXPIRATION DATE `F - 50- ?-.L WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y )C PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE ft DEPTH ft REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM i. DESTRUCTION INSTALLATION WILL SERVE: - RESIDENCE - COMMERCIAL - OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ' LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft Permit/ Invoice # Permit ID# Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUMMINIMUMA34OUR AM44NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL t2O9) 953-7697 SIGNEDAL--gTITLE /Ie -O-% DATE S -'4 - Z If �iii.■i■■■■■ilii■■■■■■■■■■■■■■■■■■■■■■■■■I■■■, Re PE SC Received hec Code INFO B ash Amount Remitted Date Permit/ Invoice # Permit ID# Service Request # aaa sa3 s US 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18