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t A R <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />IVON-KEFUNDABLE PERMIT GALL (LUBJ VOJ-/DJ/ FOR INSPEGfIONS tXPIKES T TEAK FKOM UAI I_ 155Ut <br />JOB ADDRESS 1725 Sangunetti Ln CRy/ZIp Stockton 95205 <br />CROSS STREET Cherokee Ln. 1. 1 9PN 1172500 (C PARCEL SIZE <br />OWNER NAME Wayne Bogart 'U{7 �4i) Qi Y`r 3 KGerPr L T1Z PHONE (209)943-2881 <br />OWNER ADDRESS Sangunetti Ln CITY/STATE/ZIP Stockton Ca 95205 <br />CONTRACTOR Haley Contracting PHONE 209-463-2517 <br />CONTRACTOR ADDRESS /4228 Newton Rd //t� (� CITY/STATE/ZIP Stockton CA 952e005 <br />LICENSE ❑ C-42 L �C-36 OTHER A I lJ NUMBER �� EXPIRATION DATE -V D o ll.-` <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />17 PERC TEST # <br />I BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED IAL RNATIVE <br />ft FOUNDATION <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION TGI �'. k <br />INSTALLATION WILL <br />SERVE: RESIDENCE <br />COMMERCIAL <br />VK <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />WIDTH <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />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 />DEPARTMENTUS ONLY y�! <br />Application Accepted By ��r L— Date r7% Area Employee ID# <br />Final Inspection By( Date ' SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS rx',Ak11t:hJIA r r,G%IIL S('d ;- . t ' %p %N <br />PE SCce' a Check#/ Amount Date PermlU Invoice # Permit ID# <br />Code INFO Cash Remitted Service <br />y oiS 's.2 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />VED <br />2021 <br />COUNTY <br />ENTAL <br />kRTMENT <br />