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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT GALL ZU9 90J -/b9/ FOR INSPECTIONS CXPIRES T T EAR F <br />JOB ADDRESS 2- Z2. (SIA CITY2w 1 inti° n <br />CROSS STREET- ` r"�l�/Y�V �l VlJ L APN - L. C L� PARCEL SIZE <br />OWNER NAME V�ky` `T r Gay ke'i PHONE <br />OWNER ADDRESS <br />1� IrQ IN/STATE/ZIP//I /VJ�� %���{//y� 2 <br />CONTRACTOR Y �tfi S+ CON S� M�/O�lGp\/L� _ IncI PHONE `0 1• ✓✓ 1• -7�J' <br />CONTRACTOR ADDRESS 33 I' W� 4 I S�• C� I CIN/STATE/ZIP LQ D\- 2Gh X52�1D <br />LICENSE C-42 C-36 OTHER A NUMBER ✓� • EXPIRATION DATE Zd2 i <br />D <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION V <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />ft PROPERTY LINE ft <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL <br />SERVE: RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACI I <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DEPTH ft <br />DISTANCE To NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />161 LEACH LINES <br />LEACHING CHAMBERS I I OIL <br />DYS # OF LINES <br />Z <br />LENGTH OF LINES Liu It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />fl <br />DEPTH ft <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />It LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LFNGTH <br />ft <br />DEPTH ft <br />DISTANCETO NEnac1cT <br />` <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER_ 1 <br />_ WIDTH <br />4V <br />ft <br />DEPTH ZS�It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />I HEREBY CERTIFY THAT <br />I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED \t."kA TITLE .1l1 OC.Cr l.ourafrmt Y DATE _ 10 IZU? I 2�, <br />Yop COV <br />�FpgR MFNT <br />Application Accepted V ' ^' Date T/ 1 L"I eV 1 Area <br />in ~ , <br />�.� Employee ID# k <br />Final Inspec"­ By Date 3%r`SPECIAL MRIT- Approved I \ <br />by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS ' t - r-'''11 f <br />'�' `L> . <br />cP1 ' <br />1-l I'ir424 .;rD lA i k" "r IJ I,tL I <br />PE I SCReceived Amount Permit/ <br />Code INFO By Remitted D�1e Service Reauest # Invoice # Permit IINY <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14118 <br />