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r <br />t <br />I <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />I4UN-11IEFUNUABLE PERMIT GALL (ZU`J) V0J-10J/ FOR INSPECTIONS LXPIRES 7 YEAR FROM DATE ISSUE <br />JOB ADDRESS I3LZp1�O N`1• GAL -LING F-�• 7 CITY/ZIP Lot) I aS L40 /� <br />CROSS STREET R r C �'`Nr �' T �,. tT APN 0 U, > 2" - I PARCEL SIZE " x - <br />OWNER NAME 4 �, V 0-NYK V K ` E c- Yel d'Df > PH`ONE �G- 4� 1 <br />OWNER ADDRESS �� D ' 3aX 233 1 CITY/STATE/ZIP L- 00 1 CA ` !� Z14 ( <br />CONTRACTOR LIVE OAK GtD�N�1(LoNN'LEnTC'f\L- PHONE 3L,9-C>3'1!;- <br />CONTRACTOR <br />1,9-0311CONTRACTOR ADDRESS 4401 W . OhVK S —I. CITY/STATE/ZIP `-00 1 C" \ 9'&'7-446 <br />LICENSE 'E "_.0-42 ❑L CG36 OTHER C Lis NUMBER Z I S 1 EXPIRATION DATE 4 - 7��0 - -'-4- <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # BP- LI 041--10 <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED/ALTERNATIVE <br />DISTANCE TO NEAREST <br />_ REPLACEMENT _ <br />OUT -OF -SERVICE SEPTIC <br />SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: LI RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPEIMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />WELL <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 />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />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 R ADY4NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 2953-769 <br />SIGNED TITLE P/2-03 • M &-IZ DATE <br />H <br />O <br />F <br />O �._._ _ _ _ _ AYMEIdY <br />s ! I ECEIVED <br />JIEP 2 2 2022 <br />JOAQUIN COUNTY <br />� -RONMENTAL <br />i TH DEPARTMENT <br />�I <br />DEPARTMENT PSEONLY <br />Application Accepted By Date !206a2/2Area qL Employee ID# rL vlk G <br />Final Inspection By Date � Z 2 ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft P' ump Soil ChIter: y► <br />COMMENTS �t V,� i s�S I fL6 'ar � ase <br />PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# <br />Cade INFO B Cash Remitted vi e u <br />baa sa3 IS ` <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />